Methods and compositions for the treatment of gastrointestinal disorders

ABSTRACT

The present invention features compositions and related methods for treating IBS and other gastrointestinal disorders and conditions (e.g., gastrointestinal motility disorders, functional gastrointestinal disorders, gastroesophageal reflux disease (GERD), duodenogastric reflux, Crohn&#39;s disease, ulcerative colitis, Inflammatory bowel disease, functional heartburn, dyspepsia (including functional dyspepsia or nonulcer dyspepsia), gastroparesis, chronic intestinal pseudo-obstruction (or colonic pseudo-obstruction), and disorders and conditions associated with constipation, e.g., constipation associated with use of opiate pain killers, post-surgical constipation (post-operative ileus), and constipation associated with neuropathic disorders as well as other conditions and disorders using peptides and other agents that activate the guanylate cyclase C (GC-C) receptor.

CLAIM OF PRIORITY

This application is a continuation in part of U.S. Utility patentapplication Ser. No. 10/899,806, filed Jul. 27, 2004, which is acontinuation in part of U.S. Utility patent application Ser. No.10/845,895, filed May 14, 2004, which is a continuation in part of U.S.Utility patent application Ser. No. 10/796,719, filed Mar. 9, 2004,which is a continuation in part of U.S. Utility patent application Ser.No. 10/766,735, filed Jan. 28, 2004, which claims priority under 35 USC§119(e) to U.S. Provisional Patent Application Ser. No. 60/443,098,filed on Jan. 28, 2003; U.S. Provisional Patent Application Ser. No.60/471,288, filed on May 15, 2003 and U.S. Provisional PatentApplication Ser. No. 60/519,460, filed on Nov. 12, 2003, the entirecontents of which are hereby incorporated by reference.

TECHNICAL FIELD

This invention relates to methods and compositions for treating variousdisorders, including gastrointestinal disorders, obesity, congestiveheart failure and benign prostatic hyperplasia.

BACKGROUND

Irritable bowel syndrome (IBS) is a common chronic disorder of theintestine that affects 20 to 60 million individuals in the US alone(Lehman Brothers, Global Healthcare-Irritable bowel syndrome industryupdate, September 1999). IBS is the most common disorder diagnosed bygastroenterologists (28% of patients examined) and accounts for 12% ofvisits to primary care physicians (Camilleri 2001, Gastroenterology120:652-668). In the US, the economic impact of IBS is estimated at $25billion annually, through direct costs of health care use and indirectcosts of absenteeism from work (Talley 1995, Gastroenterology109:1736-1741). Patients with IBS have three times more absenteeism fromwork and report a reduced quality of life. Sufferers may be unable orunwilling to attend social events, maintain employment, or travel evenshort distances (Drossman 1993, Dig Dis Sci 38:1569-1580). There is atremendous unmet medical need in this population since few prescriptionoptions exist to treat IBS.

Patients with IBS suffer from abdominal pain and a disturbed bowelpattern. Three subgroups of IBS patients have been defined based on thepredominant bowel habit: constipation-predominant (c-IBS),diarrhea-predominant (d-IBS) or alternating between the two (a-IBS).Estimates of individuals who suffer from c-IBS range from 20-50% of theIBS patients with 30% frequently cited. In contrast to the other twosubgroups that have a similar gender ratio, c-IBS is more common inwomen (ratio of 3:1) (Talley et al. 1995, Am J Epidemiol 142:76-83).

The definition and diagnostic criteria for IBS have been formalized inthe “Rome Criteria” (Drossman et al. 1999, Gut 45:Suppl 11: 1-81), whichare well accepted in clinical practice. However, the complexity ofsymptoms has not been explained by anatomical abnormalities or metabolicchanges. This has led to the classification of IBS as a functional GIdisorder, which is diagnosed on the basis of the Rome criteria andlimited evaluation to exclude organic disease (Ringel et al. 2001, AnnuRev Med 52: 319-338). IBS is considered to be a “biopsychosocial”disorder resulting from a combination of three interacting mechanisms:altered bowel motility, an increased sensitivity of the intestine orcolon to pain stimuli (visceral sensitivity) and psychosocial factors(Camilleri 2001, Gastroenterology 120:652-668). Recently, there has beenincreasing evidence for a role of inflammation in etiology of IBS.Reports indicate that subsets of IBS patients have small but significantincreases in colonic inflammatory and mast cells, increased induciblenitric oxide (NO) and synthase (iNOS) and altered expression ofinflammatory cytokines (reviewed by Talley 2000, Medscape Coverage ofDDW week).

SUMMARY

The present invention features compositions and related methods fortreating IBS and other gastrointestinal disorders and conditions (e.g.,gastrointestinal motility disorders, functional gastrointestinaldisorders, gastroesophageal reflux disease (GERD), duodenogastricreflux, Crohn's disease, ulcerative colitis, inflammatory bowel disease,functional heartburn, dyspepsia (including functional dyspepsia ornonulcer dyspepsia), gastroparesis, chronic intestinalpseudo-obstruction (or colonic pseudo-obstruction)), and disorders andconditions associated with constipation, e.g., constipation associatedwith use of opiate pain killers, post-surgical constipation, andconstipation associated with neuropathic disorders as well as otherconditions and disorders. The compositions feature peptides thatactivate the guanylate cyclase C (GC-C) receptor.

The present invention also features compositions and related methods fortreating obesity, congestive heart failure and benign prostatichyperplasia (BPH).

Without being bound by any particular theory, in the case of IBS andother gastrointestinal disorders the peptides are useful because theymay increase gastrointestinal motility.

Without being bound by any particular theory, in the case of IBS andother gastrointestinal disorders the peptides are useful, in part,because they may decrease inflammation.

Without being bound by any particular theory, in the case of IBS andother gastrointestinal disorders the peptides are also useful becausethey may decrease gastrointestinal pain or visceral pain.

The invention features pharmaceutical compositions comprising certainpeptides that are capable of activating the guanylate-cyclase C (GC-C)receptor. Also within the invention are pharmaceutical compositionscomprising a peptide or GC-C agonist of the invention and one or moreadditional therapeutic agents including, without limitation, the agentsdescribed herein. The other agents can be administered with the peptidesof the invention (simultaneously or sequentially). They can also belinked to a peptide of the invention to create therapeutic conjugates.

The invention includes methods for treating various gastrointestinaldisorders by administering a peptide that acts as a partial or completeagonist of the GC-C receptor. The peptide includes at least sixcysteines that can form three disulfide bonds. In certain embodimentsthe disulfide bonds are replaced by other covalent cross-links and insome cases the cysteines are substituted by other residues to providefor alternative covalent cross-links. The peptides may also include atleast one trypsin or chymotrypsin cleavage site and/or an amino orcarboxy-terminal analgesic peptide or small molecule, e.g., AspPhe orsome other analgesic peptide. When present within the peptide, theanalgesic peptide or small molecule may be preceded by a chymotrypsin ortrypsin cleavage site that allows release of the analgesic peptide orsmall molecule. The peptides and methods of the invention are alsouseful for treating pain and inflammation associated with variousdisorders, including gastrointestinal disorders. Certain peptidesinclude a functional chymotrypsin or trypsin cleavage site located so asto allow inactivation of the peptide upon cleavage. Certain peptideshaving a functional cleavage site undergo cleavage and gradualinactivation in the digestive tract, and this is desirable in somecircumstances. In certain peptides, a functional chymotrypsin site isaltered, increasing the stability of the peptide in vivo.

The invention includes methods for treating other disorders such ascongestive heart failure and benign prostatic hyperplasia byadministering a peptide or small molecule (parenterally or orally) thatacts as an agonist of the GC-C receptor. Such agents can be used incombination with natriuretic peptides (e.g., atrial natriuretic peptide,brain natriuretic peptide or C-type natriuretic peptide), a diuretic, oran inhibitor of angiotensin converting enzyme.

The invention features methods and compositions for increasingintestinal motility. Intestinal motility involves spontaneouscoordinated dissentions and contractions of the stomach, intestines,colon and rectum to move food through the gastrointestinal tract duringthe digestive process.

In certain embodiments the peptides include either one or two or morecontiguous negatively charged amino acids (e.g., Asp or Glu) or one ortwo or more contiguous positively charged residues (e.g., Lys or Arg) orone or two or more contiguous positively or negatively charged aminoacids at the carboxy terminus. In these embodiments all of the flankingamino acids at the carboxy terminus are either positively or negativelycharged. In other embodiments the carboxy terminal charged amino acidsare preceded by a Leu. For example, the following amino acid sequencescan be added to the carboxy terminus of the peptide: Asp; Asp Lys; LysLys Lys Lys Lys Lys; Asp Lys Lys Lys Lys Lys Lys; Leu Lys Lys; and LeuAsp. It is also possible to simply add Leu at the carboxy terminus.

In a first aspect, the invention features a peptide comprising,consisting of, or consisting essentially of the amino acid sequence (I):

(SEQ ID NO:1) Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁Xaa₁₂ Xaa₁₃ X_(aa14) Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₅ Xaa₁₉ Xaa₂₀ Xaa₂₁

In some embodiments Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ is Asn Ser Ser Asn Tyr oris missing or Xaa₁ Xaa₂ Xaa₃ Xaa₄ is missing.

In certain embodiments Xaa₈, Xaa₉, Xaa₁₂, Xaa₁₄, Xaa₁₆, Xaa₁₇, and Xaa₁₉can be any amino acid. In certain embodiments Xaa₈, Xaa₉, Xaa₁₂, Xaa₁₄,Xaa₁₆, Xaa₁₇, and Xaa₁₉ can be any natural or non-natural amino acid oramino acid analog.

In certain embodiments Xaa₅ is Asn, Trp, Tyr, Asp, or Phe. In otherembodiments, Xaa₅ can also be Thr or Ile. In other embodiments Xaa₅ isTyr, Asp or Trp. In certain embodiments Xaa₅ is Asn, Trp, Tyr, Asp, Ile,Thr or Phe. In certain embodiments Xaa₅ is Asn.

In some embodiments Xaa₈ is Glu, Asp, Gln, Gly or Pro. In otherembodiments Xaa₈ is Glu. In other embodiments Xaa₈ is Glu or Asp. Inothers it is Asn, Glu, or Asp. In others it is Glu, His, Lys, Gln, Asn,or Asp. In others it is Glu, His, Gln, Asn, or Asp. In others it is Glu,Asn, His, Gln, Lys, Asp or Ser. In still others it is Pro. In certainembodiments it is any natural or non-natural amino acid or amino acidanalog.

In some embodiments Xaa₉ is Leu, Ile, Val, Ala, Lys, Arg, Trp, Tyr orPhe. In some embodiments Xaa₉ is Leu, Ile, Val, Lys, Arg, Trp, Tyr orPhe. In others it is Leu, Ile, Val, Trp, Tyr or Phe. In others it isLeu, Ile or Val. In others it is Trp, Tyr or Phe. In others it is Leu,Ile, Lys, Arg, Trp, Tyr, or Phe. In others it is Leu, Val, Ile, or Met.In others it is Leu or Phe. In others it is Leu, Phe, or Tyr. In othersit is Tyr, Phe or His. In others it is Phe, His, Trp, or Tyr. In certainembodiments, Xaa₉ is not Leu. In others it is Tyr. In other embodimentsit is any natural or non-natural aromatic amino acid or amino acidanalog. In certain embodiments it is any natural or non-natural aminoacid or amino acid analog.

In certain embodiments, Xaa₂ is Asn, Tyr, Asp or Ala. In others it isAsn. In others it is Asn, Met, Arg, Lys, His, or Gln. In others it isAsn, Lys, His, or Gln. In others it is Asn, Asp, Glu or Gln. In othersit is Asn, Thr, Ser, Arg, Lys, Gln, or His. In others it is Asn, Ser, orHis. In certain embodiments it is any natural or non-natural amino acidor amino acid analog.

In certain embodiments, Xaa₁₃ is Ala, Pro or Gly. In others it is Pro orGly. In others it is Pro and in still others it is Gly.

In certain embodiments, Xaa₁₄ is Ala, Leu, Ser, Gly, Val, Glu, Gln, Ile,Leu, Thr, Lys, Arg, or Asp. In others it is Ala or Gly. In others it isVal or Ala. In others it is Ala or Thr. In others it is Ala. In othersit is Val, Gln, Asn, Glu, Asp, Thr, or Ala. In others it is Gly, Cys orSer. In still others it is Thr. In certain embodiments it is any naturalor non-natural amino acid or amino acid analog.

In certain embodiments Xaa₁₆ is Thr, Ala, Asn, Lys, Arg, Trp, Gly orVal. In others it is Thr, Ala, Asn, Lys, Arg or Trp. In others it isThr, Ala, Lys, Arg or Trp. In certain embodiments it is Thr, Ala or Trp.In others it is Thr. In certain embodiments it is Trp, Tyr or Phe. Incertain embodiments it is Thr or Ala. In certain embodiments it is Val.In certain embodiments it is Gly. In others it is Thr, Ser, Met or Val.In others it is Val, Ala, or Thr. In others it is Ile, Val, Lys, Asn,Glu, Asp, or Thr. In certain embodiments it is any natural ornon-natural amino acid or amino acid analog. In certain embodiments itis any natural or non-natural non-aromatic amino acid or amino acidanalog.

In certain embodiments Xaa₁₇ is Gly, Pro or Ala. In certain embodimentsit is Gly. In certain embodiments it is Ala. In others it is Gly or Ala.In others it is Gly, Asn, Ser or Ala. In others it is Asn, Glu, Asp,Thr, Ala, Ser, or Gly. In others it is Asp, Ala, Ser, or Gly. In certainembodiments it is any natural or non-natural amino acid or amino acidanalog.

In certain embodiments Xaa₁₉ is Trp, Tyr, Phe, Asn, Ile, Val, His, Leu,or Arg. In certain embodiments it is Trp, Tyr, Asn or Leu. In certainembodiments it is Trp, Tyr or Phe. In others it is Tyr, Phe or His. Inothers it is Tyr or Trp. In others it is Tyr. In certain embodiments itis Leu, Ile or Val. In certain embodiments it is His. In certainembodiments it is Trp, Tyr, Phe, Asn, Ile, Val, His or Leu. In certainembodiments it is Trp, Tyr, Phe or Leu. In certain embodiments it is Tyror Leu. In certain embodiments it is Lys or Arg. In certain embodimentsit is any amino acid other than Pro, Arg, Lys, Asp or Glu. In certainembodiments it is any amino acid other than Pro. In certain embodimentsit is any natural or non-natural amino acid or amino acid analog. Incertain embodiments it is missing.

In certain embodiments Xaa₂₀ is Asp or Asn. In certain embodiments Xaa₂₀Xaa₂₁ is AspPhe or is missing or Xaa₂₀ is Asn or Glu and Xaa₂₁ ismissing or Xaa₁₉ Xaa₂₀ Xaa₂₁ is missing.

In certain embodiments, the invention features, a purified polypeptidecomprising the amino acid sequence (II):

Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂ Pro₁₃Ala₁₄ Cys₁₅ Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁wherein Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ is Asn Ser Ser Asn Tyr or is missing orXaa₁ Xaa₂ Xaa₃ Xaa₄ is missing and Xaa₅ is Asn;

Xaa₈ is Glu or Asp;

Xaa₉ is Leu, Ile, Val, Trp, Tyr or Phe;

Xaa₁₆ is Thr, Ala, Trp;

Xaa₁₉ is Trp, Tyr, Phe or Leu or is missing; and Xaa₂₀ Xaa₂₁ is AspPhe.

In various embodiments the invention features a purified polypeptidecomprising the amino acid sequence (II): Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂ Pro₁₃ Ala₁₄ Cys₁₅ Xaa₁₆ Gly₁₇ Cys₁₈Xaa₁₉ Xaa₂₀ Xaa₂₁ wherein, Xaa₉ is Leu, Ile or Val and Xaa₁₆ is Trp, Tyror Phe; Xaa₉ is Trp, Tyr or Phe, and Xaa₁₆ is Thr or Ala; Xaa₁₉ is Trp,Tyr, Phe and Xaa₂₀ Xaa₂₁ is AspPhe; and Xaa₁ Xaa₂ Xaa₃ Xaa₄ is missingand Xaa₅ is Asn; the peptide comprises fewer than 50, 40, 30 or 25 aminoacids; or fewer than five amino acids precede Cys₆.

In certain embodiments the peptide includes a peptide comprising orconsisting of the amino acid sequence Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys CysGlu Xaa₉ Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Xaa₂₀ Xaa₂₁ (II) (SEQID NO:2) wherein Xaa₉ is any amino acid: wherein Xaa₉ is any amino acidother than Leu; wherein Xaa₉ is selected from Phe, Trp and Tyr; whereinXaa₉ is selected from any other natural or non-natural aromatic aminoacid; wherein Xaa₉ is Tyr; wherein Xaa₉ is Phe; wherein Xaa₉ is Trp;wherein Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ is Asn Ser Ser Asn Tyr; wherein Xaa₁,Xaa₂, Xaa₃, Xaa₄, and Xaa₅ are missing; wherein Xaa₁, Xaa₂, Xaa₃ andXaa₄ are missing; wherein Xaa₁, Xaa₂ and Xaa₃ are missing; wherein Xaa₁and Xaa₂ are missing; wherein Xaa₁ is missing; wherein Xaa₂₀ Xaa₂₁ isAspPhe or is missing or Xaa₂₀ is Asn or Glu and Xaa₂₁ is missing orXaa₁₉ Xaa₂₀ Xaa₂₁ is missing; wherein Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ and TyrXaa₂₀ Xaa₂₁ are missing. In the case of a peptide comprising thesequence (I): Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁Xaa₁₂ Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ wherein:Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ is missing and/or the sequence Xaa₁₉ Xaa₂₀Xaa₂₁ is missing, the peptide can still contain additionalcarboxyterminal or amino terminal amino acids or both. In the case ofpeptides missing one or more terminal amino acids such as Xaa₁ or Xaa₂₁,the peptide can still contain additional carboxyterminal or aminoterminal amino acids or both.

In certain embodiments, the peptide includes disulfide bonds betweenCys₆ and Cys₁₁, between Cys₇ and Cys₁₅ and between Cys₁₀ and Cys₁₆. Inother embodiments, the peptide is a reduced peptide having no disulfidebonds. In still other embodiments the peptide has one or two disulfidebonds chosen from: a disulfide bond between Cys₆ and Cys₁₁, a disulfidebond between Cys₇ and Cys₁₅ and a disulfide bond between Cys₁₀ andCys₁₆.

In certain embodiments, one or more amino acids can be replaced by anon-naturally occurring amino acid or a naturally or non-naturallyoccurring amino acid analog. There are many amino acids beyond thestandard 20. Some are naturally-occurring others are not (see, forexample, Hunt, The Non-Protein Amino Acids: In Chemistry andBiochemistry of the Amino Acids, Barrett, Chapman and Hall, 1985). Forexample, an aromatic amino acid can be replaced by3,4-dihydroxy-L-phenylalanine, 3-iodo-L-tyrosine, triiodothyronine,L-thyroxine, phenylglycine (Phg) or nor-tyrosine (norTyr). Phg andnorTyr and other amino acids including Phe and Tyr can be substitutedby, e.g., a halogen, —CH₃, —OH, —CH₂NH₃, —C(O)H, —CH₂CH₃, —CN,—CH₂CH₂CH₃, —SH, or another group. Any amino acid can be substituted bythe D-form of the amino acid.

With regard to non-naturally occurring amino acids or a naturally andnon-naturally occurring amino acid analogs, a number of substitutions inthe peptide of formula I or the peptide of formula II are possible aloneor in combination.

Xaa₈ can be replaced by gamma-Hydroxy-Glu or gamma-Carboxy-Glu.

Xaa₉ can be replaced by an alpha substituted amino acid such asL-alpha-methylphenylalanine or by analogues such as: 3-Amino-Tyr;Tyr(CH₃); Tyr(PO₃(CH₃)₂); Tyr(SO₃H); beta-Cyclohexyl-Ala;beta-(1-Cyclopentenyl)-Ala; beta-Cyclopentyl-Ala; beta-Cyclopropyl-Ala;beta-Quinolyl-Ala; beta-(2-Thiazolyl)-Ala; beta-(Triazole-1-yl)-Ala;beta-(2-Pyridyl)-Ala; beta-(3-Pyridyl)-Ala; Amino-Phe; Fluoro-Phe;Cyclohexyl-Gly; tBu-Gly; beta-(3-benzothienyl)-Ala;beta-(2-thienyl)-Ala; 5-Methyl-Trp; and 4-Methyl-Trp.

Xaa₁₃ can be an N(alpha)-C(alpha) cyclized amino acid analogues with thestructure:

Xaa₁₃ can also be homopro (L-pipecolic acid); hydroxy-Pro;3,4-Dehydro-Pro; 4-fluoro-Pro; or alpha-methyl-Pro.

When Xaa₁₃ is Gly, Ala, Leu or Val, Xaa₁₄ can be:

Xaa₁₄ can also be an alpha-substituted or N-methylated amino acid suchas alpha-amino isobutyric acid (aib), L/D-alpha-ethylalanine(L/D-isovaline), L/D-methylvaline, or L/D-alpha-methylleucine or anon-natural amino acid such as beta-fluoro-Ala.

Xaa₁₇ can be alpha-amino isobutyric acid (aib) or L/D-alpha-ethylalanine(L/D-isovaline).

Further examples of unnatural amino acids include: an unnatural analogueof tyrosine; an unnatural analogue of glutamine; an unnatural analogueof phenylalanine; an unnatural analogue of serine; an unnatural analogueof threonine; an alkyl, aryl, acyl, azido, cyano, halo, hydrazine,hydrazide, hydroxyl, alkenyl, alkynl, ether, thiol, sulfonyl, seleno,ester, thioacid, borate, boronate, phospho, phosphono, phosphine,heterocyclic, enone, imine, aldehyde, hydroxylamine, keto, or aminosubstituted amino acid, or any combination thereof; an amino acid with aphotoactivatable cross-linker; a spin-labeled amino acid; a fluorescentamino acid; an amino acid with a novel functional group; an amino acidthat covalently or noncovalently interacts with another molecule; ametal binding amino acid; a metal-containing amino acid; a radioactiveamino acid; a photocaged and/or photoisomerizable amino acid; a biotinor biotin-analogue containing amino acid; a glycosylated or carbohydratemodified amino acid; a keto containing amino acid; amino acidscomprising polyethylene glycol or polyether; a heavy atom substitutedamino acid (e.g., an amino acid containing deuterium, tritium, ¹³C, ¹⁵N,or ¹⁸O); a chemically cleavable or photocleavable amino acid; an aminoacid with an elongated side chain; an amino acid containing a toxicgroup; a sugar substituted amino acid, e.g., a sugar substituted serineor the like; a carbon-linked sugar-containing amino acid; a redox-activeamino acid; an α.-hydroxy containing acid; an amino thio acid containingamino acid; an α, α disubstituted amino acid; a β-amino acid; a cyclicamino acid other than proline; an O-methyl-L-tyrosine; anL-3-(2-naphthyl)alanine; a 3-methyl-phenylalanine; ap-acetyl-L-phenylalanine; an 0-4-allyl-L-tyrosine; a4-propyl-L-tyrosine; a tri-O-acetyl-GlcNAcβ-serine; an L-Dopa; afluorinated phenylalanine; an isopropyl-L-phenylalanine; ap-azido-L-phenylalanine; a p-acyl-L-phenylalanine; ap-benzoyl-L-phenylalanine; an L-phosphoserine; a phosphonoserine; aphosphonotyrosine; a p-iodo-phenylalanine; a 4-fluorophenylglycine; ap-bromophenylalanine; a p-amino-L-phenylalanine; anisopropyl-L-phenylalanine; L-3-(2-naphthyl)alanine; an amino-,isopropyl-, or O-allyl-containing phenylalanine analogue; a dopa,O-methyl-L-tyrosine; a glycosylated amino acid; ap-(propargyloxy)phenylalanine; dimethyl-Lysine; hydroxy-proline;mercaptopropionic acid; methyl-lysine; 3-nitro-tyrosine; norleucine;pyro-glutamic acid; Z (Carbobenzoxyl); ε-Acetyl-Lysine; β-alanine;aminobenzoyl derivative; aminobutyric acid (Abu); citrulline;aminohexanoic acid; aminoisobutyric acid; cyclohexylalanine;d-cyclohexylalanine; hydroxyproline; nitro-arginine;nitro-phenylalanine; nitro-tyrosine; norvaline; octahydroindolecarboxylate; ornithine; penicillamine; tetrahydroisoquinoline;acetamidomethyl protected amino acids and pegylated amino acids. Furtherexamples of unnatural amino acids and amino acid analogs can be found inU.S. 20030108885, U.S. 20030082575, and the references cited therein.

In some embodiments, an amino acid can be replaced by anaturally-occurring, non-essential amino acid, e.g., taurine.

Methods to manufacture peptides containing unnatural amino acids can befound in, for example, U.S. 20030108885, U.S. 20030082575, Deiters etal., J Am Chem Soc. (2003) 125:11782-3, Chin et al., Science (2003)301:964-7, and the references cited therein.

Peptides that include non-natural amino acids can also be prepared usingthe methods described in WO02086075

The peptides of the invention can have one or more conventional peptidebonds replaced by an alternative bond. Such replacements can increasethe stability of the peptide. For example, replacement of the peptidebond between Cys₁₈ and Xaa₁₉ with an alternative bond can reducecleavage by carboxy peptidases and may increase half-life in thedigestive tract. Bonds that can replace peptide bonds include: aretro-inverso bonds (C(O)—NH instead of NH—C(O); a reduced amide bond(NH—CH₂); a thiomethylene bond (S—CH₂ or CH₂—S); an oxomethylene bond(O—CH₂ or CH₂—O); an ethylene bond (CH₂—CH₂); a thioamide bond(C(S)—NH); a trans-olefine bond (CH═CH); an fluoro substitutedtrans-olefine bond (CF═CH); a ketomethylene bond (C(O)—CHR or CHR—C(O)wherein R is H or CH₃; and a fluoro-ketomethylene bond (C(O)—CFR orCFR—C(O) wherein R is H or F or CH₃.

The peptides of the invention can be modified using standardmodifications. Modifications may occur at the amino (N—), carboxy (C—)terminus, internally or a combination of any of the preceeding. In oneaspect of the invention, there may be more than one type of modificationof the peptide. Modifications include but are not limited to:acetylation, amidation, biotinylation, cinnamoylation, farnesylation,formylation, myristoylation, palmitoylation, phosphorylation (Ser, Tyror Thr), stearoylation, succinylation, sulfurylation and cyclisation(via disulfide bridges or amide cyclisation), and modification by Cy3 orCy5. The peptides of the invention may also be modified by2,4-dinitrophenyl (DNP), DNP-lysin, modification by7-Amino-4-methyl-coumarin (AMC), flourescein, NBD(7-Nitrobenz-2-Oxa-1,3-Diazole), p-nitro-anilide, rhodamine B, EDANS(5-((2-aminoethyl)amino)naphthalene-1-sulfonic acid), dabcyl, dabsyl,dansyl, texas red, FMOC, and Tamra (Tetramethylrhodamine). The peptidesof the invention may also be conjugated to, for example, polyethyleneglycol (PEG); alkyl groups (e.g., C₁-C₂₀ straight or branched alkylgroups); fatty acid radicals; combinations of PEG, alkyl groups andfatty acid radicals (see U.S. Pat. No. 6,309,633; Soltero et al., 2001Innovations in Pharmaceutical Technology 106-110); BSA and KLH (KeyholeLimpet Hemocyanin).

The peptides and agonists of the invention can be chemically modified toincrease therapeutic activity by synthetically adding sugar moieties (WO88/02756; WO 89/09786; DE 3910667 A1, EP 0 374 089 A2; and U.S. Pat. No.4,861,755), adding cationic anchors (EP0363589), lipid moieties(WO91/09837; U.S. Pat. No. 4,837,303) or the substituents described ascompounds I, II, and III in U.S. Pat. No. 5,552,520.

When Xaa₉ is Trp, Tyr or Phe or when Xaa₁₆ is Trp the peptide has apotentially functional chymotrypsin cleavage site that is located at aposition where cleavage may alter GC-C receptor binding by the peptide.When Xaa₉ is Lys or Arg or when Xaa₁₆ is Lys or Arg, the peptide has apotentially functional trypsin cleavage site that is located at aposition where cleavage may alter GC-C receptor binding by the peptide.

When Xaa₁₉ is Trp, Tyr or Phe, the peptide has a chymotrypsin cleavagesite that is located at a position where cleavage will liberate theportion of the peptide carboxy-terminal to Xaa₁₉. When Xaa₁₉ is Leu, Ileor Val, the peptide can have a chymotrypsin cleavage site that islocated at a position where cleavage will liberate the portion of thepeptide amino-terminal to Xaa₁₉. At relatively high pH the same effectis seen when Xaa₁₉ is His. When Xaa₁₉ is Lys or Arg, the peptide has atrypsin cleavage site that is located at a position where cleavage willliberate portion of the peptide carboxy-terminal to Xaa₁₉. Thus, if thepeptide includes an analgesic peptide carboxy-terminal to Xaa₁₉, thepeptide will be liberated in the digestive tract upon exposure to theappropriate protease. Among the analgesic peptides which can be includedin the peptide and/or coadministered with the peptide are: AspPhe (asXaa₂₀Xaa₂₁), endomorphin-1, endomorphin-2, nocistatin, dalargin, lupron,ziconotide, and substance P and other analgesic peptides describedherein. These peptides can, for example, be used to replace Xaa₂₀Xaa₂₁.

When Xaa₁ or the amino-terminal amino acid of the peptide of theinvention (e.g., Xaa₂ or Xaa₃) is Trp, Tyr or Phe, the peptide has achymotrypsin cleavage site that is located at a position where cleavagewill liberate the portion of the peptide amino-terminal to Xaa₁ (or Xaa₂or Xaa₃) along with Xaa₁, Xaa₂ or Xaa₃. When Xaa₁ or the amino-terminalamino acid of the peptide of the invention (e.g., Xaa₂ or Xaa₃) is Lysor Arg, the peptide has a trypsin cleavage site that is located at aposition where cleavage will liberate portion of the peptideamino-terminal to Xaa₁ along with Xaa₁, Xaa₂ or Xaa₃). When Xaa₁ or theamino-terminal amino acid of the peptide of the invention is Leu, Ile orVal, the peptide can have a chymotrypsin cleavage site that is locatedat a position where cleavage will liberate the portion of the peptideamino-terminal to Xaa₁. At relatively high pH the same effect is seenwhen Xaa₁ is His. Thus, for example, if the peptide includes ananalgesic peptide amino-terminal to Xaa₁, the peptide will be liberatedin the digestive tract upon exposure to the appropriate protease. Amongthe analgesic peptides which can be included in the peptide are: AspPhe,endomorphin-1, endomorphin-2, nocistatin, dalargin, lupron, andsubstance p and other analgesic peptides described herein.

When fully folded, disulfide bonds may be present between: Cys₆ andCys₁₁; Cys₇ and Cys₁₅; and Cys₁₀ and Cys₁₈. The peptides of theinvention bear some sequence similarity to ST peptides. However, theyinclude amino acid changes and/or additions that improve functionality.These changes can, for example, increase or decrease activity (e.g.,increase or decrease the ability of the peptide to stimulate intestinalmotility), alter the ability of the peptide to fold correctly, alter thestability of the peptide, alter the ability of the peptide to bind theGC-C receptor and/or decrease toxicity. In some cases the peptides mayfunction more desirably than wild-type ST peptide. For example, they maylimit undesirable side effects such as diarrhea and dehydration.

In some embodiments one or both members of one or more pairs of Cysresidues which normally form a disulfide bond can be replaced byhomocysteine, penicillamine, 3-mercaptoproline (Kolodziej et al. 1996Int J Pept Protein Res 48:274); β,β dimethylcysteine (Hunt et al. 1993Int J Pept Protein Res 42:249) or diaminopropionic acid (Smith et al.1978 J Med Chem 21:117) to form alternative internal cross-links at thepositions of the normal disulfide bonds.

In addition, one or more disulfide bonds can be replaced by alternativecovalent cross-links, e.g., an amide linkage (—CH₂CH(O)NHCH₂— or—CH₂NHCH(O)CH₂—), an ester linkage, a thioester linkage, a lactambridge, a carbamoyl linkage, a urea linkage, a thiourea linkage, aphosphonate ester linkage, an alkyl linkage (—CH₂CH₂CH₂CH₂—), an alkenyllinkage (—CH₂CH═CHCH₂—), an ether linkage (—CH₂CH₂OCH₂— or—CH₂OCH₂CH₂—), a thioether linkage (—CH₂CH₂SCH₂— or —CH₂SCH₂CH₂—), anamine linkage (—CH₂CH₂NHCH₂— or —CH₂NHCH₂CH₂—) or a thioamide linkage(—CH₂CH(S)HNHCH₂— or —CH₂NHCH(S)CH₂—). For example, Ledu et al. (ProcNat'l Acad. Sci. 100:11263-78, 2003) describe methods for preparinglactam and amide cross-links. Schafineister et al. (J. Am. Chem. Soc.122:5891, 2000) describes stable, hydrocarbon cross-links. Hydrocarboncross links can be produced via metathesis (or methathesis followed byhydrogenation in the case of saturated hydrocarbons cross-links) usingone or another of the Grubbs catalysts (available from Materia, Inc. andSigma-Aldrich and described, for example, in U.S. Pat. Nos. 5,831,108and 6,111,121). In some cases, the generation of such alternativecross-links requires replacing the Cys residues with other residues suchas Lys or Glu or non-naturally occurring amino acids. In addition thelactam, amide and hydrocarbon cross-links can be used to stabilize thepeptide even if they link amino acids at positions other than thoseoccupied by Cys. Such cross-links can occur between two amino acids thatare separated by two amino acids or between two amino acids that areseparated by six amino acids (see, e.g., Schafineister et al. (J. Am.Chem. Soc. 122:5891, 2000)).

In the case of a peptide comprising the sequence (I): Xaa₁ Xaa₂ Xaa₃Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ or Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys Cys GluXaa₉ Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Xaa₂₀ Xaa₂₁ (II) wherein:Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ is missing and/or the sequence Xaa₁₉ Xaa₂₀Xaa₂₁ is missing, the peptide can still contain additionalcarboxyterminal or amino terminal amino acids or both. For example, thepeptide can include an amino terminal sequence that facilitatesrecombinant production of the peptide and is cleaved prior toadministration of the peptide to a patient. The peptide can also includeother amino terminal or carboxyterminal amino acids. In some cases theadditional amino acids protect the peptide, stabilize the peptide oralter the activity of the peptide. In some cases some or all of theseadditional amino acids are removed prior to administration of thepeptide to a patient. The peptide can include 1, 2, 3, 4, 5, 10, 15, 20,25, 30, 40, 50, 60, 70 80, 90, 100 or more amino acids at its aminoterminus or carboxy terminus or both. The number of flanking amino acidsneed not be the same. For example, there can be 10 additional aminoacids at the amino terminus of the peptide and none at the carboxyterminus.

In one embodiment the peptide comprises the amino acid sequence (I):Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ wherein: Xaa₁ Xaa₂ Xaa₃Xaa₄ Xaa₅ is missing; Xaa₈ is Glu; Xaa₉ is Leu, Ile, Lys, Arg, Trp, Tyror Phe; Xaa₁₂ is Asn; Xaa₁₃ is Pro; Xaa₁₄ is Ala; Xaa₁₆ is Thr, Ala,Lys, Arg, Trp; Xaa₁₇ is Gly; Xaa₁₉ is Tyr or Leu; and Xaa₂₀ Xaa₂₁ isAspPhe or is missing. Where Xaa₂₀ Xaa₂₁ and/or Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅are missing, there may be additional flanking amino acids in someembodiments. In certain embodiments of a composition comprising apeptide having the sequence (I): Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀Xaa₂₁, the peptide does not comprise or consist of any of the peptidesof Table I.

In a second aspect, the invention also features a therapeutic orprophylactic method comprising administering to a patient apharmaceutical composition comprising or consisting essentially of apurified peptide comprising, consisting of or consisting essentially ofthe amino acid sequence: Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁(I) or Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂Pro₁₃ Ala₁₄ Cys₁₅ Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (II) as describedherein.

The peptides can be co-administered with or linked, e.g., covalentlylinked to any of a variety of other peptides or compounds includinganalgesic peptides or analgesic compounds including, without limitation,the agents described herein.

Amino acid, non-amino acid, peptide and non-peptide spacers can beinterposed between a peptide that is a GC-C receptor agonist and apeptide that has some other biological function, e.g., an analgesicpeptide or a peptide used to treat obesity. The linker can be one thatis cleaved from the flanking peptides in vivo or one that remains linkedto the flanking peptides in vivo. For example, glycine, beta-alanine,glycyl-glycine, glycyl-beta-alanine, gamma-aminobutyric acid,6-aminocaproic acid, L-phenylalanine, L-tryptophan andglycil-L-valil-L-phenylalanine can be used as spacers (Chaltin et al.2003 Helvetica Chimica Acta 86:533-547; Caliceti et al. 1993 FARMCO48:919-32) as can polyethylene glycols (Butterworth et al. 1987 J. Med.Chem. 30:1295-302) and maleimide derivatives (King et al. 2002Tetrahedron Lett. 43:1987-1990). Various other linkers are described inthe literature (Nestler 1996 Molecular Diversity 2:35-42; Finn et al.1984 Biochemistry 23:2554-8; Cook et al. 1994 Tetrahedron Lett.35:6777-80; Brokx et al. 2002 Journal of Controlled Release 78:115-123;Griffin et al. 2003 J. Am. Chem. Soc. 125:6517-6531; Robinson et al.1998 Proc. Natl. Acad. Sci. USA 95:5929-5934).

The peptides of the invention can be attached to one, two or moredifferent moieties each providing the same or different functions. Forexample, the peptide can be linked to a molecule that is an analgesicand to a peptide that is used to treat obesity. The peptide and variousmoieties can be ordered in various ways. For example, a peptide of theinvention can have an analgesic peptide linked to its amino terminus andan anti-obesity peptide linked to its carboxy terminus. The additionalmoieties can be directly covalently bonded to the peptide or can bebonded via linkers.

The peptides of the invention can be a cyclic peptide or a linearpeptide. In addition, multiple copies of the same peptide can beincorporated into a single cyclic or linear peptide.

The peptides can include the amino acid sequence of a peptide thatoccurs naturally in a vertebrate (e.g., mammalian) species or in abacterial species. In addition, the peptides can be partially orcompletely non-naturally occurring peptides. Also within the inventionare peptidomimetics corresponding to the peptides of the invention.

In various embodiments, the patient is suffering from a gastrointestinaldisorder; the patient is suffering from a disorder selected from thegroup consisting of: a gastrointestinal motility disorder, irritablebowel syndrome, chronic constipation, post-operative ileus, a functionalgastrointestinal disorder, gastroesophageal reflux disease,duodenogastric reflux, functional heartburn, dyspepsia, functionaldyspepsia, nonulcer dyspepsia, gastroparesis, chronic intestinalpseudo-obstruction, Crohn's disease, ulcerative colitis, Irritable bowelsyndrome, colonic pseudo-obstruction, obesity, congestive heart failure,or benign prostatic hyperplasia; the composition is administered orally;the peptide comprises 30 or fewer amino acids, the peptide comprises 20or fewer amino acids, and the peptide comprises no more than 5 aminoacids prior to Cys₆; the peptide comprises 150, 140, 130, 120, 110, 100,90, 80, 70, 60, 50, 40, or 30 or fewer amino acids. In otherembodiments, the peptide comprises 20 or fewer amino acids. In otherembodiments the peptide comprises no more than 20, 15, 10, or 5 peptidessubsequent to Cys₁₈. In certain embodiments Xaa₁₉ is a chymotrypsin ortrypsin cleavage site and an analgesic peptide is present immediatelyfollowing Xaa₁₉.

In a third aspect, the invention features a method for treating apatient suffering from constipation. Clinically accepted criteria thatdefine constipation range from the frequency of bowel movements, theconsistency of feces and the ease of bowel movement. One commondefinition of constipation is less than three bowel movements per week.Other definitions include abnormally hard stools or defecation thatrequires excessive straining (Schiller 2001, Aliment Pharmacol Ther15:749-763). Constipation may be idiopathic (functional constipation orslow transit constipation) or secondary to other causes includingneurologic, metabolic or endocrine disorders. These disorders includediabetes mellitus, hypothyroidism, hyperthyroidism, hypocalcaemia,Multiple Sclerosis, Parkinson's disease, spinal cord lesions,Neurofibromatosis, autonomic neuropathy, Chagas disease, Hirschsprung'sdisease and Cystic fibrosis. Constipation may also be the result ofsurgery (postoperative ileus) or due to the use of drugs such asanalgesics (like opioids), antihypertensives, anticonvulsants,antidepressants, antispasmodics and antipsychotics. The method oftreating constipation comprises administering a pharmaceuticalcomposition comprising or consisting essentially of a peptidecomprising, consisting of or consisting essentially of the amino acidsequence: Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (I) or Xaa₁ Xaa₂Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂ Pro₁₃ Ala₁₄ Cys₁₅Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (II) as described herein.

In various embodiments, the constipation is associated with use of atherapeutic agent; the constipation is associated with a neuropathicdisorder; the constipation is post-surgical constipation (postoperativeileus); and the constipation associated with a gastrointestinaldisorder; the constipation is idiopathic (functional constipation orslow transit constipation); the constipation is associated withneuropathic, metabolic or endocrine disorder (e.g., diabetes mellitus,hypothyroidism, hyperthyroidism, hypocalcaemia, Multiple Sclerosis,Parkinson's disease, spinal cord lesions, neurofibromatosis, autonomicneuropathy, Chagas disease, Hirschsprung's disease or cystic fibrosis).Constipation may also be the result of surgery (postoperative ileus) ordue the use of drugs such as analgesics (e.g., opioids),antihypertensives, anticonvulsants, antidepressants, antispasmodics andantipsychotics.

In a fourth aspect, the invention features a method for treating apatient suffering a gastrointestinal disorder, the method comprisingadministering to the patient a pharmaceutical composition comprising orconsisting essentially of a purified peptide comprising, consisting ofor consisting essentially of the amino acid sequence: Xaa₁ Xaa₂ Xaa₃Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (I) or Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂ Pro₁₃ Ala₁₄ Cys₁₅ Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉Xaa₂₀ Xaa₂₁ (II) as described herein.

In various embodiments, the patient is suffering from a gastrointestinaldisorder; the patient is suffering from a disorder selected from thegroup consisting of: a gastrointestinal motility disorder, irritablebowel syndrome, chronic constipation, post-operative ileus, a functionalgastrointestinal disorder, gastroesophageal reflux disease, functionalheartburn, dyspepsia, functional dyspepsia, nonulcer dyspepsia,gastroparesis, chronic intestinal pseudo-obstruction, Crohn's disease,ulcerative colitis, Inflammatory bowel disease, colonicpseudo-obstruction, obesity, congestive heart failure, or benignprostatic hyperplasia.

In a fifth aspect, the invention features a method for increasinggastrointestinal motility in a patient, the method comprisingadministering to a patient a pharmaceutical composition comprising apurified peptide comprising, consisting of or consisting essentially ofthe amino acid sequence: Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁(I) or Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂Pro₁₃ Ala₁₄ Cys₁₅ Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (II) as describedherein.

In a sixth aspect, the invention features a method for increasing theactivity of (activating) an intestinal guanylate cyclase (GC-C) receptorin a patient, the method comprising administering to a patient apharmaceutical composition comprising a purified peptide comprising,consisting of or consisting essentially of the amino acid sequence: Xaa₁Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃ Xaa₁₄Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (I) or Xaa₁ Xaa₂ Xaa₃ Xaa₄Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂ Pro₁₃ Ala₁₄ Cys₁₅ Xaa₁₆ Gly₁₇Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (II) as described herein.

In a seventh aspect, the invention features an isolated nucleic acidmolecule comprising a nucleotide sequence encoding a polypeptidecomprising the amino acid sequence: Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉Xaa₂₀ Xaa₂₁ (I) or Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀Cys₁₁ Asn₁₂ Pro₁₃ Ala₁₄ Cys₁₅ Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (II)as described herein.

In an eighth aspect the invention features a method for treatingconstipation, the method comprising administering an agonist of theintestinal guanylate cyclase (GC-C) receptor. In various embodiments:the agonist is a peptide, the peptide includes two Cys that form onedisulfide bond, the peptide includes four Cys that form two disulfidebonds, and the peptide includes six Cys that form three disulfide bonds.

In a ninth aspect, the invention features a method for treating agastrointestinal disorder, a gastrointestinal motility disorder,irritable bowel syndrome, chronic constipation, post-operative ileus, afunctional gastrointestinal disorder, gastroesophageal reflux disease,duodenogastric reflux, functional heartburn, dyspepsia, functionaldyspepsia, nonulcer dyspepsia, gastroparesis, chronic intestinalpseudo-obstruction, colonic pseudo-obstruction, Crohn's disease,ulcerative colitis, Inflammatory bowel disease, obesity, congestiveheart failure, or benign prostatic hyperplasia, the method comprisingadministering an agonist of the intestinal guanylate cyclase (GC-C)receptor either orally, by rectal suppository, or parenterally. Invarious embodiments: the agonist is a peptide, the peptide includes twoCys that form one disulfide bond, the peptide includes four Cys thatform two disulfide bonds, and the peptide includes six Cys that formthree disulfide bonds.

In a tenth aspect, the invention features a method for treating agastrointestinal disorder selected from the group consisting of: agastrointestinal motility disorder, irritable bowel syndrome, chronicconstipation, post-operative ileus, a functional gastrointestinaldisorder, gastroesophageal reflux disease, duodenogastric reflux,functional heartburn, dyspepsia, functional dyspepsia, nonulcerdyspepsia, gastroparesis, chronic intestinal pseudo-obstruction, colonicpseudo-obstruction, Crohn's disease, ulcerative colitis, Inflammatorybowel disease, the method comprising administering an agonist of theintestinal guanylate cyclase (GC-C) receptor. In various embodiments thecomposition is administered orally; the peptide comprises 30 or feweramino acids, the peptide comprises 20 or fewer amino acids, and thepeptide comprises no more than 5 amino acids prior to Cys₅.

In various embodiments: the agonist is a peptide, the peptide includestwo Cys that form one disulfide bond, the peptide includes four Cys thatform two disulfide bonds, and the peptide includes six Cys that formthree disulfide bonds.

In an eleventh aspect, the invention features a method for treatingobesity, the method comprising administering a complete or partialagonist of the intestinal guanylate cyclase (GC-C) receptor. In variousembodiments: the agonist is a peptide, the peptide includes two Cys thatform one disulfide bond, the peptide includes four Cys that form twodisulfide bonds, and the peptide includes six Cys that form threedisulfide bonds. The agonist can be administered alone or in combinationwith one or more agents for treatment of obesity, including but notlimited to the anti-obesity agents described herein. Thus, for example,PYY3-36 can be fused to the carboxy or amino terminus of a peptide ofthe invention. Such a fusion protein can include a chymostrypsin ortrypsin cleavage site that can permit cleavage to separate the twopeptides.

In a twelfth aspect, the invention features a method for treatingobesity, the method comprising administering to a patient apharmaceutical composition comprising or consisting essentially of apurified peptide comprising, consisting of or consisting essentially ofthe amino acid sequence: Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁(I) or Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂Pro₁₃ Ala₁₄ Cys₁₅ Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (II) as describedherein.

In a thirteenth aspect, the invention features a composition comprisingor consisting essentially of a purified peptide comprising, consistingof or consisting essentially of the amino acid sequence: Xaa₁ Xaa₂ Xaa₃Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (I) or Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂ Pro₁₃ Ala₁₄ Cys₁₅ Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉Xaa₂₀ Xaa₂₁ (II) as described herein. In one embodiment, the compositionis a pharmaceutical composition.

In a fourteenth aspect, the invention features a method for treatingcongestive heart failure, the method comprising administering to apatient a pharmaceutical composition comprising or consistingessentially of a purified peptide comprising, consisting of orconsisting essentially of the amino acid sequence: Xaa₁ Xaa₂ Xaa₃ Xaa₄Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (I) or Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂ Pro₁₃ Ala₁₄ Cys₁₅ Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀Xaa₂₁ (II) as described herein.

The peptide can be administered in combination with one or more agentsfor treatment of congestive heart failure, for example, a natriureticpeptide such as atrial natriuretic peptide, brain natriuretic peptide orC-type natriuretic peptide), a diuretic, or an inhibitor of angiotensinconverting enzyme.

In a fifteenth aspect, the invention features a method for treatingbenign prostatic hyperplasia, the method comprising administering to apatient a pharmaceutical composition comprising a purified peptidecomprising, consisting of or consisting essentially of the amino acidsequence: Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (I) or Xaa₁ Xaa₂Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂ Pro₁₃ Ala₁₄ Cys₁₅Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (II) as described herein. Thepeptide can be administered alone or in combination with another agentfor treatment of BPH, for example, a 5-alpha reductase inhibitor (e.g.,finasteride) or an alpha adrenergic inhibitor (e.g., doxazosine).

In a sixteenth aspect, the invention features a method for treating orreducing pain, including visceral pain, pain associated with agastrointestinal disorder or pain associated with some other disorder,the method comprising administering to a patient a pharmaceuticalcomposition comprising or consisting essentially of a purified peptidecomprising, consisting of or consisting essentially of the amino acidsequence: Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (I) or Xaa₁ Xaa₂Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂ Pro₁₃ Ala₁₄ Cys₁₅Xaa₁₆ Gly₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (II) as described herein.

In a seventeenth aspect, the invention features a method for treatinginflammation, including inflammation of the gastrointestinal tract,e.g., inflammation associated with a gastrointestinal disorder orinfection or some other disorder, the method comprising administering toa patient a pharmaceutical composition comprising a purified peptidecomprising, consisting of or consisting essentially of the amino acidsequence: Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (I) or Xaa₁ Xaa₂Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂ Pro₁₃ Ala₁₄ Cys₁₅Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (II) as described herein.

In an eighteenth aspect, the invention features a method for treatingcongestive heart failure, the method comprising administering a completeor partial agonist of the intestinal guanylate cyclase (GC-C) receptor.The agonist can be administered alone or in combination with anotheragent for treatment of congestive heart failure, for example, anatriuretic peptide such as atrial natriuretic peptide, brainnatriuretic peptide or C-type natriuretic peptide, a diuretic, or aninhibitor of angiotensin converting enzyme.

In a nineteenth aspect, the invention features a method for treatingBPH, the method comprising administering a complete or partial agonistof the intestinal guanylate cyclase (GC-C) receptor. The agonist can beadministered alone or in combination with another agent for treatment ofBPH, for example, a 5-alpha reductase inhibitor (e.g., finasteride) oran alpha adrenergic inhibitor (e.g., doxazosine).

In a twentieth aspect, the invention features isolated nucleic acidmolecules comprising a sequence encoding a peptide of the invention.Also within the invention are vectors, e.g., expression vectors thatinclude such nucleic acid molecules and can be used to express a peptideof the invention in a cultured cell (e.g., a eukaryotice cell or aprokaryotic cell). The vector can further include one or more regulatoryelements, e.g., a heterologous promoter or elements required fortranslation operably linked to the sequence encoding the peptide. Insome cases the nucleic acid molecule will encode an amino acid sequencethat includes the amino acid sequence of a peptide of the invention. Forexample, the nucleic acid molecule can encode a preprotein or apreproprotein that can be processed to produce a peptide of theinvention.

A vector that includes a nucleotide sequence encoding a peptide of theinvention or a peptide or polypeptide comprising a peptide of theinvention may be either RNA or DNA, single- or double-stranded,prokaryotic, eukaryotic, or viral. Vectors can include transposons,viral vectors, episomes, (e.g., plasmids), chromosomes inserts, andartificial chromosomes (e.g. BACs or YACs). Suitable bacterial hosts forexpression of the encode peptide or polypeptide include, but are notlimited to, E. coli. Suitable eukaryotic hosts include yeast such as S.cerevisiae, other fungi, vertebrate cells, invertebrate cells (e.g.,insect cells), plant cells, human cells, human tissue cells, and wholeeukaryotic organisms. (e.g., a transgenic plant or a transgenic animal).Further, the vector nucleic acid can be used to transfect a virus suchas vaccinia or baculovirus (for example using the Bac-to-Bac®Baculovirus expression system (Invitrogen Life Technologies, Carlsbad,Calif.)).

As noted above the invention includes vectors and genetic constructssuitable for production of a peptide of the invention or a peptide orpolypeptide comprising such a peptide. Generally, the genetic constructalso includes, in addition to the encoding nucleic acid molecule,elements that allow expression, such as a promoter and regulatorysequences. The expression vectors may contain transcriptional controlsequences that control transcriptional initiation, such as promoter,enhancer, operator, and repressor sequences. A variety oftranscriptional control sequences are well known to those in the art andmay be functional in, but are not limited to, a bacterium, yeast, plant,or animal cell. The expression vector can also include a translationregulatory sequence (e.g., an untranslated 5′ sequence, an untranslated3′ sequence, a poly A addition site, or an internal ribosome entrysite), a splicing sequence or splicing regulatory sequence, and atranscription termination sequence. The vector can be capable ofautonomous replication or it can integrate into host DNA.

The invention also includes isolated host cells harboring one of theforgoing nucleic acid molecules and methods for producing a peptide byculturing such a cell and recovering the peptide or a precursor of thepeptide. Recovery of the peptide or precursor may refer to collectingthe growth solution and need not involve additional steps ofpurification. Proteins of the present invention, however, can bepurified using standard purification techniques, such as, but notlimited to, affinity chromatography, thermaprecipitation, immunoaffinitychromatography, ammonium sulfate precipitation, ion exchangechromatography, filtration, electrophoresis and hydrophobic interactionchromatography.

The peptides can be purified. Purified peptides are peptides separatedfrom other proteins, lipids, and nucleic acids or from the compoundsfrom which is it synthesized. The polypeptide can constitute at least10, 20, 50 70, 80 or 95% by dry weight of the purified preparation.

In a twenty-first aspect, the invention features a method of increasingthe level of cyclic guanosine 3′-monophosphate (cGMP) in an organ,tissue (e.g, the intestinal mucosa), or cell (e.g., a cell bearing GC-Areceptor) by administering to a patient a composition comprising orconsisting essentially of a purified peptide comprising, consisting ofor consisting essentially of the amino acid sequence: Xaa₁ Xaa₂ Xaa₃Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (I) or Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Asn₁₂ Pro₁₃ Ala₁₄ Cys₁₅ Xaa₁₆ Gly₁₇ Cys₁₈ Xaa₁₉Xaa₂₀ Xaa₂₁ (II) as described herein.

In a twenty-second aspect, the invention features polypeptidescomprising, consisting or consisting essentially of the amino acidsequence Xaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅ Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂Xaa₁₃ Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ wherein: a) Xaa₈or Xaa₉ is not present; b) neither Xaa₈ or Xaa₉ is present; c) one ofXaa₁₂, Xaa₁₃ and Xaa₁₄ is not present; d) two of Xaa₁₂, Xaa₁₃ and Xaa₁₄are not present; e) three of Xaa₁₂, Xaa₁₃ and Xaa₁₄ are not present; f)one of Xaa₁₆ and Xaa₁₇ is not present; g) neither Xaa₁₆ or Xaa₁₇ ispresent and combinations thereof. In various embodiments, one, two,three, four or five of Xaa₁ Xaa₂ Xaa₃ Xaa₄ and Xaa₅ are not present. Inother embodiments, one, two or three or Xaa₁₉ Xaa₂₀ and Xaa₂₁ aremissing.

In twenty third aspect, the invention features a method for treating adisorder ameliorated by increasing cGMP levels, the method comprisingadministering a pharmaceutical composition comprising, consistingessentially of or consisting of a peptide or agonist of the inventionand a pharmaceutically acceptable carrier.

Among the useful peptides are peptides comprising, consisting of orconsisting essentially of the amino acid sequence Xaa₁ Xaa₂ Xaa₃ Xaa₄Xaa₅ Cys Cys Glu Xaa₉ Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Xaa₂₀Xaa₂₁ (II) (SEQ ID NO:_) are the following peptides:

Gln Ser Ser Asn Tyr Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly CysTyr (SEQ ID NO:---) Asn Thr Ser Asn Tyr Cys Cys Glu Tyr Cys Cys Asn ProAla Cys Thr Gly Cys Tyr (SEQ ID NO:---) Asn Leu Ser Asn Tyr Cys Cys GluTyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO:---) Asn Ile SerAsn Tyr Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ IDNO:---) Asn Ser Ser Gln Tyr Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys ThrGly Cys Tyr (SEQ ID NO:---) Ser Ser Asn Tyr Cys Cys Glu Tyr Cys Cys AsnPro Ala Cys Thr Gly Cys Tyr (SEQ ID NO:---) Gln Ser Ser Gln Tyr Cys CysGlu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO:---) Ser SerGln Tyr Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr. (SEQ IDNO:---) Asn Ser Ser Asn Tyr Cys Cys Glu Ala Cys Cys Asn Pro Ala Cys ThrGly Cys Tyr (SEQ ID NO: ) Asn Ser Ser Asn Tyr Cys Cys Glu Arg Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO: ) Asn Ser Ser Asn Tyr CysCys Glu Asn Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO: ) AsnSer Ser Asn Tyr Cys Cys Glu Asp Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Asn Ser Ser Asn Tyr Cys Cys Glu Cys Cys Cys Asn Pro AlaCys Thr Gly Cys Tyr (SEQ ID NO: ) Asn Ser Ser Asn Tyr Cys Cys Glu GlnCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO: ) Asn Ser Ser AsnTyr Cys Cys Glu Glu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ IDNO: ) Asn Ser Ser Asn Tyr Cys Cys Glu Gly Cys Cys Asn Pro Ala Cys ThrGly Cys Tyr (SEQ ID NO: ) Asn Ser Ser Asn Tyr Cys Cys Glu His Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO: ) Asn Ser Ser Asn Tyr CysCys Glu Ile Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO: ) AsnSer Ser Asn Tyr Cys Cys Glu Lys Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Asn Ser Ser Asn Tyr Cys Cys Glu Met Cys Cys Asn Pro AlaCys Thr Gly Cys Tyr (SEQ ID NO: ) Asn Ser Ser Asn Tyr Cys Cys Glu PheCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO: ) Asn Ser Ser AsnTyr Cys Cys Glu Pro Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ IDNO: ) Asn Ser Ser Asn Tyr Cys Cys Glu Ser Cys Cys Asn Pro Ala Cys ThrGly Cys Tyr (SEQ ID NO: ) Asn Ser Ser Asn Tyr Cys Cys Glu Thr Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO: ) Asn Ser Ser Asn Tyr CysCys Glu Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO: ) AsnSer Ser Asn Tyr Cys Cys Glu Val Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Ala Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Arg Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Asn Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Asp Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Cys Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Gln Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Glu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Gly Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu His Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Ile Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Lys Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Met Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Pro Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Ser Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Thr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Val Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO: ) Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys (SEQID NO: ) Cys Cys Glu Ala Cys Cys Asn Pro Ala Cys Thr Gly Cys (SEQ IDNO: ) Cys Cys Glu Arg Cys Cys Asn Pro Ala Cys Thr Gly Cys (SEQ ID NO: )Cys Cys Glu Asn Cys Cys Asn Pro Ala Cys Thr Gly Cys (SEQ ID NO: ) CysCys Glu Asp Cys Cys Asn Pro Ala Cys Thr Gly Cys (SEQ ID NO: ) Cys CysGlu Cys Cys Cys Asn Pro Ala Cys Thr Gly Cys (SEQ TD NO: ) Cys Cys GluGln Cys Cys Asn Pro Ala Cys Thr Gly Cys (SEQ ID NO: ) Cys Cys Glu GluCys Cys Asn Pro Ala Cys Thr Gly Cys (SEQ ID NO: ) Cys Cys Glu Gly CysCys Asn Pro Ala Cys Thr Gly Cys (SEQ ID NO: ) Cys Cys Glu His Cys CysAsn Pro Ala Cys Thr Gly Cys (SEQ ID NO: ) Cys Cys Glu Ile Cys Cys AsnPro Ala Cys Thr Gly Cys (SEQ ID NO: ) Cys Cys Glu Lys Cys Cys Asn ProAla Cys Thr Gly Cys (SEQ ID NO: ) Cys Cys Glu Met Cys Cys Asn Pro AlaCys Thr Gly Cys (SEQ ID NO: ) Cys Cys Glu Phe Cys Cys Asn Pro Ala CysThr Gly Cys (SEQ ID NO: ) Cys Cys Glu Pro Cys Cys Asn Pro Ala Cys ThrGly Cys (SEQ ID NO: ) Cys Cys Glu Ser Cys Cys Asn Pro Ala Cys Thr GlyCys (SEQ ID NO: ) Cys Cys Glu Thr Cys Cys Asn Pro Ala Cys Thr Gly Cys;(SEQ ID NO: ) Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys (SEQID NO: ) Cys Cys Glu Val Cys Cys Asn Pro Ala Cys Thr Gly Cys. (SEQ IDNO: )

Also useful are peptides comprising, consisting of or consistingessentially of any of the following sequences:

Cys Cys Glu Leu Cys Cys Ala Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu LeuCys Cys Val Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Leu Cys Cys Leu ProAla Cys Thr Gly Cys Tyr Cys Cys Glu Leu Cys Cys Ile Pro Ala Cys Thr GlyCys Tyr Cys Cys Glu Leu Cys Cys Pro Pro Ala Cys Thr Gly Cys Tyr Cys CysGln Leu Cys Cys Met Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Leu Cys CysPhe Pro Ala Cys Tbr Gly Cys Tyr Cys Tyr Cys Cys Gln Leu Cys Cys Trp ProAla Cys Thr Gly Cys Tyr Cys Cys Gln Leu Cys Cys Gly Pro Ala Cys Thr GlyCys Tyr Cys Cys Gln Leu Cys Cys Ser Pro Ala Cys Thr Gly Cys Tyr Cys CysGln Leu Cys Cys Thr Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln Leu Cys CysCys Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln Leu Cys Cys Gln Pro Ala CysThr Gly Cys Tyr Cys Cys Gln Leu Cys Cys Tyr Pro Ala Cys Thr Gly Cys TyrCys Cys Gln Leu Cys Cys Asp Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln LeuCys Cys Gln Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln Leu Cys Cys Lys ProAla Cys Thr Gly Cys Tyr Cys Cys Gln Leu Cys Cys Arg Pro Ala Cys Thr GlyCys Tyr Cys Cys Gln Leu Cys Cys His Pro Ala Cys Thr Gly Cys Tyr Cys CysGln Tyr Cys Cys Ala Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln Tyr Cys CysVal Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln Tyr Cys Cys Leu Pro Ala CysThr Gly Cys Tyr Cys Cys Gln Tyr Cys Cys Ile Pro Ala Cys Thr Gly Cys TyrCys Cys Gln Tyr Cys Cys Pro Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln TyrCys Cys Met Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln Tyr Cys Cys Phe ProAla Cys Thr Gly Cys Tyr Cys Cys Gln Tyr Cys Cys Trp Pro Ala Cys Thr GlyCys Tyr Cys Cys Gln Tyr Cys Cys Gly Pro Ala Cys Thr Gly Cys Tyr Cys CysGln Tyr Cys Cys Ser Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln Tyr Cys CysThr Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln Tyr Cys Cys Cys Pro Ala CysThr Gly Cys Tyr Cys Cys Gln Tyr Cys Cys Gln Pro Ala Cys Thr Gly Cys TyrCys Cys Gln Tyr Cys Cys Tyr Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln TyrCys Cys Asp Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln Tyr Cys Cys Gln ProAla Cys Thr Gly Cys Tyr Cys Cys Glu Tyr Cys Cys Lys Pro Ala Cys Thr GlyCys Tyr Cys Cys Glu Tyr Cys Cys Arg Pro Ala Cys Thr Gly Cys Tyr Cys CysGlu Tyr Cys Cys His Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Leu Cys CysAla Pro Ala Cys Thr Gly Cys Cys Cys Glu Leu Cys Cys Val Pro Ala Cys ThrGly Cys Cys Cys Glu Leu Cys Cys Leu Pro Ala Cys Thr Gly Cys Cys Cys GluLeu Cys Cys Ile Pro Ala Cys Thr Gly Cys Cys Cys Glu Leu Cys Cys Pro ProAla Cys Thr Gly Cys Cys Cys Glu Leu Cys Cys Met Pro Ala Cys Thr Gly CysCys Cys Glu Leu Cys Cys Phe Pro Ala Cys Thr Gly Cys Cys Cys Glu Leu CysCys Trp Pro Ala Cys Thr Gly Cys Cys Cys Glu Leu Cys Cys Gly Pro Ala CysThr Gly Cys Cys Cys Glu Leu Cys Cys Ser Pro Ala Cys Thr Gly Cys Cys CysGlu Leu Cys Cys Thr Pro Ala Cys Thr Gly Cys Cys Cys Glu Leu Cys Cys CysPro Ala Cys Thr Gly Cys Cys Cys Glu Leu Cys Cys Gln Pro Ala Cys Thr GlyCys Cys Cys Glu Leu Cys Cys Tyr Pro Ala Cys Thr Gly Cys Cys Cys Glu LeuCys Cys Asp Pro Ala Cys Thr Gly Cys Cys Cys Glu Leu Cys Cys Glu Pro AlaCys Thr Gly Cys Cys Cys Glu Leu Cys Cys Lys Pro Ala Cys Thr Gly Cys CysCys Glu Leu Cys Cys Arg Pro Ala Cys Thr Gly Cys Cys Cys Glu Leu Cys CysHis Pro Ala Cys Thr Gly Cys Cys Cys Glu Tyr Cys Cys Ala Pro Ala Cys ThrGly Cys Cys Cys Glu Tyr Cys Cys Val Pro Ala Cys Thr Gly Cys Cys Cys GluTyr Cys Cys Leu Pro Ala Cys Thr Gly Cys Cys Cys Glu Tyr Cys Cys Ile ProAla Cys Thr Gly Cys Cys Cys Glu Tyr Cys Cys Pro Pro Ala Cys Thr Gly CysCys Cys Glu Tyr Cys Cys Met Pro Ala Cys Thr Gly Cys Cys Cys Glu Tyr CysCys Phe Pro Ala Cys Thr Gly Cys Cys Cys Glu Tyr Cys Cys Tyr Pro Ala CysThr Gly Cys Cys Cys Glu Tyr Cys Cys Gly Pro Ala Cys Thr Gly Cys Cys CysGlu Tyr Cys Cys Ser Pro Ala Cys Thr Gly Cys Cys Cys Glu Tyr Cys Cys ThrPro Ala Cys Thr Gly Cys Cys Cys Glu Tyr Cys Cys Cys Pro Ala Cys Thr GlyCys Cys Cys Glu Tyr Cys Cys Gln Pro Ala Cys Thr Gly Cys Cys Cys Glu TyrCys Cys Tyr Pro Ala Cys Thr Gly Cys Cys Cys Glu Tyr Cys Cys Asp Pro AlaCys Thr Gly Cys Cys Cys Glu Tyr Cys Cys Glu Pro Ala Cys Thr Gly Cys CysCys Glu Tyr Cys Cys Lys Pro Ala Cys Thr Gly Cys Cys Cys Glu Tyr Cys CysArg Pro Ala Cys Thr Gly Cys Cys Cys Glu Tyr Cys Cys His Pro Ala Cys ThrGly Cys Cys Cys Glu Leu Cys Cys Asn Pro Thr Cys Thr Gly Cys Tyr Cys CysGlu Tyr Cys Cys Asn Pro Thr Cys Thr Gly Cys Tyr Cys Cys Glu Leu Cys CysAsn Pro Thr Cys Thr Gly Cys Cys Cys Glu Tyr Cys Cys Asn Pro Thr Cys ThrGly Cys Cys Cys Glu Phe Cys Cys Asn Pro Thr Cys Thr Gly Cys Tyr Cys CysGlu Phe Cys Cys Asn Pro Thr Cys Thr Gly Cys Cys Cys Glu Trp Cys Cys AsnPro Thr Cys Thr Gly Cys Tyr Cys Cys Glu Trp Cys Cys Asn Pro Thr Cys ThrGly Cys Cys Cys Glu Leu Cys Cys Asn Gly Ala Cys Thr Gly Cys Tyr Cys CysGlu Tyr Cys Cys Asn Gly Ala Cys Thr Gly Cys Tyr Cys Cys Glu Leu Cys CysAsn Gly Ala Cys Thr Gly Cys Cys Cys Glu Tyr Cys Cys Asn Gly Ala Cys ThrGly Cys Cys Cys Glu Phe Cys Cys Asn Gly Ala Cys Thr Gly Cys Tyr Cys CysGlu Phe Cys Cys Asn Gly Ala Cys Thr Gly Cys Cys Cys Glu Trp Cys Cys AsnGly Ala Cys Thr Gly Cys Tyr Cys Cys Glu Trp Cys Cys Asn Gly Ala Cys ThrGly Cys Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Val Gly Cys Tyr Cys CysGlu Tyr Cys Cys Asn Pro Ala Cys Val Gly Cys Tyr Cys Cys Glu Leu Cys CysAsn Pro Ala Cys Val Gly Cys Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys ValGly Cys Cys Cys Glu Phe Cys Cys Asn Pro Ala Cys Val Gly Cys Tyr Cys CysGlu Phe Cys Cys Asn Pro Ala Cys Val Gly Cys Cys Cys Glu Trp Cys Cys AsnPro Ala Cys Val Gly Cys Tyr Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys ValGly Cys Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Gly Gly Cys Tyr Cys CysGlu Tyr Cys Cys Asn Pro Ala Cys Gly Gly Cys Tyr Cys Cys Glu Leu Cys CysAsn Pro Ala Cys Gly Gly Cys Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys GlyGly Cys Cys Cys Glu Phe Cys Cys Asn Pro Ala Cys Gly Gly Cys Tyr Cys CysGlu Phe Cys Cys Asn Pro Ala Cys Gly Gly Cys Cys Cys Glu Trp Cys Cys AsnPro Ala Cys Gly Gly Cys Tyr Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys GlyGly Cys Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Ala Cys Tyr Cys CysGlu Tyr Cys Cys Asn Pro Ala Cys Thr Ala Cys Tyr Cys Cys Glu Leu Cys CysAsn Pro Ala Cys Thr Ala Cys Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys ThrAla Cys Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys Thr Ala Cys Tyr Cys CysGlu Trp Cys Cys Asn Pro Ala Cys Thr Ala Cys Cys Cys Glu Phe Cys Cys AsnPro Ala Cys Thr Ala Cys Tyr Cys Cys Glu Phe Cys Cys Asn Pro Ala Cys ThrAla Cys Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Ala Cys CysGlu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Val Cys Cys Glu Leu Cys CysAsn Pro Ala Cys Thr Gly Cys Leu Cys Cys Glu Leu Cys Cys Asn Pro Ala CysThr Gly Cys Ile Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys ProCys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Met Cys Cys Glu LeuCys Cys Asn Pro Ala Cys Thr Gly Cys Phe Cys Cys Glu Leu Cys Cys Asn ProAla Cys Thr Gly Cys Trp Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr GlyCys Gly Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Ser Cys CysGlu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Thr Cys Cys Glu Leu Cys CysAsn Pro Ala Cys Thr Gly Cys Cys Cys Cys Glu Leu Cys Cys Asn Pro Ala CysThr Gly Cys Asn Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys GlnCys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Asp Cys Cys Glu LeuCys Cys Asn Pro Ala Cys Thr Gly Cys Glu Cys Cys Glu Leu Cys Cys Asn ProAla Cys Thr Gly Cys Lys Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr GlyCys Arg Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys His Cys CysGlu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Ala Cys Cys Glu Tyr Cys CysAsn Pro Ala Cys Thr Gly Cys Val Cys Cys Glu Tyr Cys Cys Asn Pro Ala CysThr Gly Cys Leu Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys IleCys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Pro Cys Cys Glu TyrCys Cys Asn Pro Ala Cys Thr Gly Cys Met Cys Cys Glu Tyr Cys Cys Asn ProAla Cys Thr Gly Cys Phe Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr GlyCys Trp Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Gly Cys CysGlu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Ser Cys Cys Glu Tyr Cys CysAsn Pro Ala Cys Thr Gly Cys Thr Cys Cys Glu Tyr Cys Cys Asn Pro Ala CysThr Gly Cys Cys Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys AsnCys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Gln Cys Cys Glu TyrCys Cys Asn Pro Ala Cys Thr Gly Cys Asp Cys Cys Glu Tyr Cys Cys Asn ProAla Cys Thr Gly Cys Glu Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr GlyCys Lys Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Arg Cys CysGlu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys His Cys Cys Ala Leu Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Val Leu Cys Cys Asn Pro Ala CysThr Gly Cys Tyr Cys Cys Leu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys TyrCys Cys Ile Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Met LeuCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Phe Leu Cys Cys Asn ProAla Cys Thr Gly Cys Tyr Cys Cys Trp Leu Cys Cys Asn Pro Ala Cys Thr GlyCys Tyr Cys Cys Gly Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys CysSer Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Thr Leu Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Cys Leu Cys Cys Asn Pro Ala CysThr Gly Cys Tyr Cys Cys Asn Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys TyrCys Cys Gln Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Tyr LeuCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Asp Leu Cys Cys Asn ProAla Cys Thr Gly Cys Tyr Cys Cys Lys Leu Cys Cys Asn Pro Ala Cys Thr GlyCys Tyr Cys Cys Arg Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys CysHis Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Ala Leu Cys CysAsn Pro Ala Cys Thr Gly Cys Cys Cys Val Leu Cys Cys Asn Pro Ala Cys ThrGly Cys Cys Cys Leu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys IleLeu Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Met Leu Cys Cys Asn ProAla Cys Thr Gly Cys Cys Cys Phe Leu Cys Cys Asn Pro Ala Cys Thr Gly CysCys Cys Thr Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Gly Leu CysCys Asn Pro Ala Cys Thr Gly Cys Cys Cys Ser Leu Cys Cys Asn Pro Ala CysThr Gly Cys Cys Cys Thr Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys CysCys Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Asn Leu Cys Cys AsnPro Ala Cys Thr Gly Cys Cys Cys Gln Leu Cys Cys Asn Pro Ala Cys Thr GlyCys Cys Cys Tyr Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Asp LeuCys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Lys Leu Cys Cys Asn Pro AlaCys Thr Gly Cys Cys Cys Arg Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys CysCys His Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Ala Tyr Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Val Tyr Cys Cys Asn Pro Ala CysThr Gly Cys Tyr Cys Cys Leu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys TyrCys Cys Ile Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Met TyrCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Phe Tyr Cys Cys Asn ProAla Cys Thr Gly Cys Tyr Cys Cys Trp Tyr Cys Cys Asn Pro Ala Cys Thr GlyCys Tyr Cys Cys Gly Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys CysSer Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Thr Tyr Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Cys Tyr Cys Cys Asn Pro Ala CysThr Gly Cys Tyr Cys Cys Asn Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys TyrCys Cys Gln Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Tyr TyrCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Asp Tyr Cys Cys Asn ProAla Cys Thr Gly Cys Tyr Cys Cys Lys Tyr Cys Cys Asn Pro Ala Cys Thr GlyCys Tyr Cys Cys Arg Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys CysHis Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Ala Tyr Cys CysAsn Pro Ala Cys Thr Gly Cys Cys Cys Val Tyr Cys Cys Asn Pro Ala Cys ThrGly Cys Cys Cys Leu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys IleTyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Met Tyr Cys Cys Asn ProAla Cys Thr Gly Cys Cys Cys Phe Tyr Cys Cys Asn Pro Ala Cys Thr Gly CysCys Cys Trp Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Gly Tyr CysCys Asn Pro Ala Cys Thr Gly Cys Cys Cys Ser Tyr Cys Cys Asn Pro Ala CysThr Gly Cys Cys Cys Thr Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys CysCys Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Asn Tyr Cys Cys AsnPro Ala Cys Thr Gly Cys Cys Cys Gln Tyr Cys Cys Asn Pro Ala Cys Thr GlyCys Cys Cys Tyr Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Asp TyrCys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Lys Tyr Cys Cys Asn Pro AlaCys Thr Gly Cys Cys Cys Arg Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys CysCys His Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Glu Phe Cys CysAla Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Phe Cys Cys Val Pro Ala CysThr Gly Cys Tyr Cys Cys Glu Phe Cys Cys Leu Pro Ala Cys Thr Gly Cys TyrCys Cys Glu Phe Cys Cys Ile Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu PheCys Cys Pro Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Phe Cys Cys Met ProAla Cys Thr Gly Cys Tyr Cys Cys Glu Phe Cys Cys Phe Pro Ala Cys Thr GlyCys Tyr Cys Cys Glu Phe Cys Cys Trp Pro Ala Cys Thr Gly Cys Tyr Cys CysGlu Phe Cys Cys Gly Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Phe Cys CysSer Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Phe Cys Cys Thr Pro Ala CysThr Gly Cys Tyr Cys Cys Glu Phe Cys Cys Cys Pro Ala Cys Thr Gly Cys TyrCys Cys Glu Phe Cys Cys Gln Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu PheCys Cys Tyr Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Phe Cys Cys Asp ProAla Cys Thr Gly Cys Tyr Cys Cys Glu Phe Cys Cys Glu Pro Ala Cys Thr GlyCys Tyr Cys Cys Glu Phe Cys Cys Lys Pro Ala Cys Thr Gly Cys Tyr Cys CysGlu Phe Cys Cys Arg Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Phe Cys CysHis Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Phe Cys Cys Ala Pro Ala CysThr Gly Cys Cys Cys Glu Phe Cys Cys Val Pro Ala Cys Thr Gly Cys Cys CysGlu Phe Cys Cys Leu Pro Ala Cys Thr Gly Cys Cys Cys Glu Phe Cys Cys IlePro Ala Cys Thr Gly Cys Cys Cys Glu Phe Cys Cys Pro Pro Ala Cys Thr GlyCys Cys Cys Glu Phe Cys Cys Met Pro Ala Cys Thr Gly Cys Cys Cys Glu PheCys Cys Phe Pro Ala Cys Thr Gly Cys Cys Cys Glu Phe Cys Cys Trp Pro AlaCys Thr Gly Cys Cys Cys Glu Phe Cys Cys Gly Pro Ala Cys Thr Gly Cys CysCys Glu Phe Cys Cys Ser Pro Ala Cys Thr Gly Cys Cys Cys Glu Phe Cys CysThr Pro Ala Cys Thr Gly Cys Cys Cys Glu Phe Cys Cys Cys Pro Ala Cys ThrGly Cys Cys Cys Glu Phe Cys Cys Gln Pro Ala Cys Thr Gly Cys Cys Cys GluPhe Cys Cys Tyr Pro Ala Cys Thr Gly Cys Cys Cys Glu Phe Cys Cys Asp ProAla Cys Thr Gly Cys Cys Cys Glu Phe Cys Cys Glu Pro Ala Cys Thr Gly CysCys Cys Glu Phe Cys Cys Lys Pro Ala Cys Thr Gly Cys Cys Cys Glu Phe CysCys Arg Pro Ala Cys Thr Gly Cys Cys Cys Glu Phe Cys Cys His Pro Ala CysThr Gly Cys Cys Cys Glu Trp Cys Cys Ala Pro Ala Cys Thr Gly Cys Tyr CysCys Glu Trp Cys Cys Val Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Trp CysCys Leu Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Trp Cys Cys Ile Pro AlaCys Thr Gly Cys Tyr Cys Cys Glu Trp Cys Cys Pro Pro Ala Cys Thr Gly CysTyr Cys Cys Glu Trp Cys Cys Met Pro Ala Cys Thr Gly Cys Tyr Cys Cys GluTrp Cys Cys Phe Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Trp Cys Cys TrpPro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Trp Cys Cys Gly Pro Ala Cys ThrGly Cys Tyr Cys Cys Glu Trp Cys Cys Ser Pro Ala Cys Thr Gly Cys Tyr CysCys Glu Trp Cys Cys Thr Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Trp CysCys Cys Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Trp Cys Cys Gln Pro AlaCys Thr Gly Cys Tyr Cys Cys Glu Trp Cys Cys Tyr Pro Ala Cys Thr Gly CysTyr Cys Cys Glu Trp Cys Cys Asp Pro Ala Cys Thr Gly Cys Tyr Cys Cys GluTrp Cys Cys Glu Pro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Trp Cys Cys LysPro Ala Cys Thr Gly Cys Tyr Cys Cys Glu Trp Cys Cys Arg Pro Ala Cys ThrGly Cys Tyr Cys Cys Glu Trp Cys Cys His Pro Ala Cys Thr Gly Cys Tyr CysCys Glu Trp Cys Cys Ala Pro Ala Cys Thr Gly Cys Cys Cys Glu Trp Cys CysVal Pro Ala Cys Thr Gly Cys Cys Cys Glu Trp Cys Cys Leu Pro Ala Cys ThrGly Cys Cys Cys Glu Trp Cys Cys Ile Pro Ala Cys Thr Gly Cys Cys Cys GluTrp Cys Cys Pro Pro Ala Cys Thr Gly Cys Cys Cys Glu Trp Cys Cys Met ProAla Cys Thr Gly Cys Cys Cys Glu Trp Cys Cys Phe Pro Ala Cys Thr Gly CysCys Cys Glu Trp Cys Cys Trp Pro Ala Cys Thr Gly Cys Cys Cys Glu Trp CysCys Gly Pro Ala Cys Thr Gly Cys Cys Cys Glu Trp Cys Cys Ser Pro Ala CysThr Gly Cys Cys Cys Glu Trp Cys Cys Thr Pro Ala Cys Thr Gly Cys Cys CysGlu Trp Cys Cys Cys Pro Ala Cys Thr Gly Cys Cys Cys Glu Trp Cys Cys GlnPro Ala Cys Thr Gly Cys Cys Cys Glu Trp Cys Cys Tyr Pro Ala Cys Thr GlyCys Cys Cys Glu Trp Cys Cys Asp Pro Ala Cys Thr Gly Cys Cys Cys Glu TrpCys Cys Glu Pro Ala Cys Thr Gly Cys Cys Cys Glu Trp Cys Cys Lys Pro AlaCys Thr Gly Cys Cys Cys Glu Trp Cys Cys Arg Pro Ala Cys Thr Gly Cys CysCys Glu Trp Cys Cys His Pro Ala Cys Thr Gly Cys Cys Cys Glu Trp Cys CysAsn Pro Ala Cys Thr Gly Cys Ala Cys Cys Glu Trp Cys Cys Asn Pro Ala CysThr Gly Cys Val Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys LeuCys Cys Glu Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Ile Cys Cys Glu TrpCys Cys Asn Pro Ala Cys Thr Gly Cys Pro Cys Cys Glu Trp Cys Cys Asn ProAla Cys Thr Gly Cys Met Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys Thr GlyCys Phe Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Trp Cys CysGlu Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Gly Cys Cys Glu Trp Cys CysAsn Pro Ala Cys Thr Gly Cys Ser Cys Cys Glu Trp Cys Cys Asn Pro Ala CysThr Gly Cys Thr Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys CysCys Cys Glu Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Asn Cys Cys Glu TrpCys Cys Asn Pro Ala Cys Thr Gly Cys Gln Cys Cys Glu Trp Cys Cys Asn ProAla Cys Thr Gly Cys Asp Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys Thr GlyCys Glu Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Lys Cys CysGlu Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Arg Cys Cys Glu Trp Cys CysAsn Pro Ala Cys Thr Gly Cys His Cys Cys Glu Phe Cys Cys Asn Pro Ala CysThr Gly Cys Ala Cys Cys Glu Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys ValCys Cys Glu Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Leu Cys Cys Glu PheCys Cys Asn Pro Ala Cys Thr Gly Cys Ile Cys Cys Glu Phe Cys Cys Asn ProAla Cys Thr Gly Cys Pro Cys Cys Glu Phe Cys Cys Asn Pro Ala Cys Thr GlyCys Met Cys Cys Glu Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Phe Cys CysGlu Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Trp Cys Cys Glu Phe Cys CysAsn Pro Ala Cys Thr Gly Cys Gly Cys Cys Glu Phe Cys Cys Asn Pro Ala CysThr Gly Cys Ser Cys Cys Glu Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys ThrCys Cys Glu Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Cys Glu PheCys Cys Asn Pro Ala Cys Thr Gly Cys Asn Cys Cys Glu Phe Cys Cys Asn ProAla Cys Thr Gly Cys Gln Cys Cys Glu Phe Cys Cys Asn Pro Ala Cys Thr GlyCys Asp Cys Cys Glu Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Glu Cys CysGlu Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Lys Cys Cys Glu Phe Cys CysAsn Pro Ala Cys Thr Gly Cys Arg Cys Cys Glu Phe Cys Cys Asn Pro Ala CysThr Gly Cys His Cys Cys Ala Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys TyrCys Cys Val Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Leu PheCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Ile Phe Cys Cys Asn ProAla Cys Thr Gly Cys Tyr Cys Cys Met Phe Cys Cys Asn Pro Ala Cys Thr GlyCys Tyr Cys Cys Phe Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys CysTrp Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gly Phe Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Ser Phe Cys Cys Asn Pro Ala CysThr Gly Cys Tyr Cys Cys Thr Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys TyrCys Cys Cys Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Asn PheCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln Phe Cys Cys Asn ProAla Cys Thr Gly Cys Tyr Cys Cys Tyr Phe Cys Cys Asn Pro Ala Cys Thr GlyCys Tyr Cys Cys Asp Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys CysLys Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Arg Phe Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr Cys Cys His Phe Cys Cys Asn Pro Ala CysThr Gly Cys Tyr Cys Cys Ala Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys CysCys Val Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Leu Phe Cys CysAsn Pro Ala Cys Thr Gly Cys Cys Cys Ile Phe Cys Cys Asn Pro Ala Cys ThrGly Cys Cys Cys Met Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys PhePhe Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Trp Phe Cys Cys Asn ProAla Cys Thr Gly Cys Cys Cys Gly Phe Cys Cys Asn Pro Ala Cys Thr Gly CysCys Cys Ser Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Thr Phe CysCys Asn Pro Ala Cys Thr Gly Cys Cys Cys Cys Phe Cys Cys Asn Pro Ala CysThr Gly Cys Cys Cys Asn Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys CysGln Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Tyr Phe Cys Cys AsnPro Ala Cys Thr Gly Cys Cys Cys Asp Phe Cys Cys Asn Pro Ala Cys Thr GlyCys Cys Cys Lys Phe Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Arg PheCys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys His Phe Cys Cys Asn Pro AlaCys Thr Gly Cys Cys Cys Ala Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys TyrCys Cys Val Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Leu TrpCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Ile Trp Cys Cys Asn ProAla Cys Thr Gly Cys Tyr Cys Cys Met Trp Cys Cys Asn Pro Ala Cys Thr GlyCys Tyr Cys Cys Phe Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys CysTrp Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gly Trp Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Ser Trp Cys Cys Asn Pro Ala CysThr Gly Cys Tyr Cys Cys Thr Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys TyrCys Cys Cys Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Asn TrpCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Gln Trp Cys Cys Asn ProAla Cys Thr Gly Cys Tyr Cys Cys Tyr Trp Cys Cys Asn Pro Ala Cys Thr GlyCys Tyr Cys Cys Asp Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys CysLys Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Cys Cys Arg Trp Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr Cys Cys His Trp Cys Cys Asn Pro Ala CysThr Gly Cys Tyr Cys Cys Ala Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys CysCys Val Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Leu Trp Cys CysAsn Pro Ala Cys Thr Gly Cys Cys Cys Ile Trp Cys Cys Asn Pro Ala Cys ThrGly Cys Cys Cys Met Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys PheTrp Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Trp Trp Cys Cys Asn ProAla Cys Thr Gly Cys Cys Cys Gly Trp Cys Cys Asn Pro Ala Cys Thr Gly CysCys Cys Ser Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Thr Trp CysCys Asn Pro Ala Cys Thr Gly Cys Cys Cys Cys Trp Cys Cys Asn Pro Ala CysThr Gly Cys Cys Cys Asn Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys CysGln Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Tyr Trp Cys Cys AsnPro Ala Cys Thr Gly Cys Cys Cys Asp Trp Cys Cys Asn Pro Ala Cys Thr GlyCys Cys Cys Lys Trp Cys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys Arg TrpCys Cys Asn Pro Ala Cys Thr Gly Cys Cys Cys His Trp Cys Cys Asn Pro AlaCys Thr Gly

The invention also features deletion variants of any of the peptidesdescribed herein in which one, two, three or four amino acids (ornon-natural amino acids or natural or non-natural amino acid analogs),other than a Cys (or an amino acid substituted for Cys, e.g, an aminoacid capable of forming a covalent bond to another amino acid), aredeleted. Where two (or more) amino acids are deleted and the peptidecomprises the sequence: Cys_(a) Cys_(b) Xaa Xaa Cys_(c) Cys_(d) Xaa XaaXaa Cys_(e) Xaa Xaa Cys_(f), in some embodiments two or more deletionscan be located between Cys_(b) and Cys_(c) and/or between Cys_(d) andCys_(e) and/or between Cys_(e) and Cys_(f). However, in otherembodiments there is at most one deletion between each of Cys_(b) andCys_(c) or between Cys_(d) and Cys_(e) or between Cys_(e) and Cys_(f).Thus, the invention includes any of the peptides described hereincomprising the sequence Cys_(a) Cys_(b) Xaa Xaa Cys_(c) Cys_(d) Xaa XaaXaa Cys_(e) Xaa Xaa Cys_(f) wherein: a) one amino acid between Cys_(b)and Cys_(c) is deleted; b) one amino acid between Cys_(d) and Cys_(e) isdeleted; c) one amino acid between Cys_(e) and Cys_(f) is deleted; d)one amino acid between Cys_(b) and Cys_(c) is deleted and one amino acidbetween Cys_(d) and Cys_(e) is deleted; e) one amino acid betweenCys_(d) and Cys_(e) is deleted and one amino acid between Cys_(e) andCys_(f) is deleted; f) one amino acid between Cys_(b) and Cys_(c) isdeleted and one amino acid between Cys_(e) and Cys_(f) is deleted or g)one amino acid between Cys_(b) and Cys_(c) is deleted, one amino acidbetween Cys_(d) and Cys_(e) is deleted and one amino acid betweenCys_(e) and Cys_(f) is deleted. In certain embodiments, the variousdeletion variants are peptides that bind to and/or activate the GC-Creceptor. In various embodiments, the various deletion variants arepeptides that increase cGMP levels.

Deletion variants of Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly CysTyr (SEQ ID NO:3) include the peptides listed in FIG. 11. In thesedeletion variants, any of the amino acids can be deleted and there canbe one, two, three or four amino acids deleted other than Cys.

The invention also features insertion variants of any of the peptidesdescribed herein in which one, two, three or four amino acids (e.g., Glyor Ala) are inserted before or after any amino acid in the peptide. Insome embodiments no more than one amino acid is inserted between twoCys. For example, where two or more amino acids are inserted and thepeptide comprises the sequence Cys_(a) Cys_(b) Xaa Xaa Cys_(c) Cys_(d)Xaa Xaa Xaa Cys_(e) Xaa Xaa Cys_(f), in some embodiments two or moreinsertions can be located between Cys_(b) and Cys_(c) or between Cys_(d)and Cys_(e) or between Cys_(e) and Cys_(f). However, in otherembodiments no more than one insertion is located between Cys_(b) andCys_(c) or between Cys_(d) and Cys_(e) or between Cys_(e) and Cys_(f).Thus, the invention features any of the peptides described hereincomprising the sequence Cys_(a) Cys_(b) Xaa Xaa Cys_(c) Cys_(d) Xaa XaaXaa Cys_(e) Xaa Xaa Cys_(f) wherein: a) one amino acid is insertedbetween Cys_(b) and Cys_(c); b) one amino acid is inserted betweenCys_(d) and Cys_(e); c) one amino acid is inserted between Cys_(e) andCys_(f); d) one amino acid is inserted between Cys_(b) and Cys_(c) andone amino acid is inserted between Cys_(d) and Cys_(e); e) one aminoacid is inserted between Cys_(d) and Cys_(e) and one amino acid isinserted between Cys_(e) and Cys_(f); f) one amino acid is insertedbetween Cys_(b) and Cys_(c) and one amino acid is inserted betweenCys_(e) and Cys_(f); or g) one amino acid is inserted between Cys_(b)and Cys_(c), one amino acid is inserted between Cys_(d) and Cys_(e) andone amino acid is inserted between Cys_(e) and Cys_(f). In addition, oneor more amino acids can be inserted preceding Cys_(a) and/or one or moreamino acids can be inserted following Cys_(f).

In various embodiments, the various insertion variants are peptides thatbind to and/or activate the GC-C receptor. In various embodiments, thevarious insertion variants are peptides that increase cGMP levels.

Insertion variants of Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr GlyCys Tyr (SEQ ID NO:3) include those in which up to four amino acids(i.e., 0, 1, 2, 3 or 4) can be inserted after each amino acid. Thus, theinvention includes peptides having the sequence: Cys Xaa₍₀₋₄₎ CysXaa₍₀₋₄₎ Glu Xaa₍₀₋₄₎ Tyr Xaa₍₀₋₄₎ Cys Xaa₍₀₋₄₎ Cys Xaa₍₀₋₄₎ AsnXaa₍₀₋₄₎ Pro Xaa₍₀₋₄₎ Ala Xaa₍₀₋₄₎ Cys Xaa₍₀₋₄₎ Thr Xaa₍₀₋₄₎ GlyXaa₍₀₋₄₎ Cys Xaa₍₀₋₄₎ Tyr Xaa₍₀₋₄₎₎ (SEQ ID NO:). The inserted aminoacids can be any amino acid or amino acid analog (natural ornon-natural) and can be the same or different. In certain embodimentsthe inserted amino acids are all Gly or all Ala or a combination of Glyand Ala.

FIG. 12 depicts insertion variants of the peptide having the sequence:Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO:3).

The invention also features variants of peptides having the sequenceXaa₁ Xaa₂ Xaa₃ Xaa₄ Xaa₅Cys₆ Cys₇ Xaa₈ Xaa₉ Cys₁₀ Cys₁₁ Xaa₁₂ Xaa₁₃Xaa₁₄ Cys₁₅ Xaa₁₆ Xaa₁₇ Cys₁₈ Xaa₁₉ Xaa₂₀ Xaa₂₁ (SEQ ID NO:1), e.g.,variants of Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQID NO:3), in which up to four amino acids are deleted and/or up to fouramino acids are inserted. The insertions and deletions can be betweenCys₆ and Cys₁₈ in SEQ ID NO:1 or they can be amino terminal to Cys₆and/or carboxy terminal to Cys₁₈ in SEQ ID NO:1.

The invention also features peptides which may include one or more ofthe peptide modifications, one or more non-natural amino acid or aminoacid analogs, one or more of the disulfide bond alternatives or one moreof the alternative peptide bonds described herein.

The peptides of the invention can be present with a counterion. Usefulcounterions include salts of: acetate, benzenesulfonate, benzoate,calcium edetate, camsylate, carbonate, citrate, edetate (EDTA),edisylate, embonate, esylate, fumarate, gluceptate, gluconate,glutamate, glycollylarsanilate, hexylresorcinate, iodide, bromide,chloride, hydroxynaphthoate, isethionate, lactate, lactobionate,estolate, maleate, malate, mandelate, mesylate, mucate, napsylate,nitrate, pantothenate, phosphate, salicylate, stearate, succinate,sulfate, tartarate, theoclate, acetamidobenzoate, adipate, alginate,aminosalicylate, anhydromethylenecitrate, ascorbate, aspartate,camphorate, caprate, caproate, caprylate, cinnamate, cyclamate,dichloroacetate, formate, gentisate, glucuronate, glycerophosphate,glycolate, hippurate, fluoride, malonate, napadisylate, nicotinate,oleate, orotate, oxalate, oxoglutarate, palmitate, pectinate, pectinatepolymer, phenylethylbarbiturate, picrate, propionate, pidolate,sebacate, rhodanide, tosylate, and tannate.

The peptides and agonist of the intestinal guanylate cyclase (GC-C)receptor can be used to treat constipation or decreased intestinalmotility, slow digestion or slow stomach emptying. The peptides can beused to relieve one or more symptoms of IBS (bloating, pain,constipation), GERD (acid reflux into the esophagus), duodenogastricreflux, functional dyspepsia, or gastroparesis (nausea, vomiting,bloating, delayed gastric emptying) and other disorders describedherein.

The details of one or more embodiments of the invention are set forth inthe accompanying description. All of the publications, patents andpatent applications are hereby incorporated by reference.

FIGURES

FIG. 1 depicts the results of LCMS analysis of recombinant SEQ ID NO:4peptide and SEQ ID NO:5 peptide.

FIGS. 1 b and c depict the results of LCMS analysis of synthetic SEQ IDNO:3 peptide and the blank.

FIG. 2 depicts the results of the intestinal GC-C receptor activityassay of synthetic SEQ ID NO:4 peptide, SEQ ID NO:5 peptide and twodifferent SEQ ID NO:3 peptides.

FIG. 3 a depicts the effect of recombinant SEQ ID NO:4 peptide andZelnorm® in an acute murine gastrointestinal transit model.

FIG. 3 b depicts the effect of synthetic SEQ ID NO:3 peptide andZelnorm® in an acute murine gastrointestinal transit model.

FIGS. 4 a and 4 b depict the effect of peptides SEQ ID NO:5, SEQ IDNO:3, and SEQ ID NO:4 in an acute murine gastrointestinal transit model.

FIG. 4 c depicts the effect of SEQ ID NO:3 peptide in a chronic murinegastrointestinal transit model.

FIG. 5 a depicts the effect of SEQ ID NO:4 peptide and Zelnorm® in asuckling mouse intestinal secretion model.

FIG. 5 b depicts the effects of SEQ ID NO:3 and Zelnorm® in a mouseintestinal secretion model.

FIGS. 6 a and 6 b depict the effects of SEQ ID NO:4, SEQ ID NO:3 and SEQID NO:5 peptides in a mouse intestinal secretion model.

FIG. 7 shows the results of experiment in which SEQ ID NO:3 activity wasanalyzed in the TNBS colonic distention model.

FIGS. 8 a and 8 b show the effects of differing doses of SEQ ID NO:5 andSEQ ID NO:3 in the PBQ writhing assay.

FIG. 9 shows the results of Kd determination analysis using SEQ ID NO:3in a competitive radioligand binding assay.

FIGS. 10 a and 10 b show bioavailability data for IV and orallyadministered SEQ ID NO:3 as detected by an ELISA assay and LCMS.

FIG. 11 depicts deletion variants of a peptide having the sequence ofSEQ ID NO:3.

FIG. 12 depicts insertion variants of a peptide having the sequence ofSEQ ID NO:3.

DETAILED DESCRIPTION

The peptides of the invention bind to the intestinal guanylate cyclase(GC-C) receptor, a key regulator of fluid and electrolyte balance in theintestine. When stimulated, this receptor, which is located on theapical membrane of the intestinal epithelial surface, causes an increasein intestinal epithelial cyclic GMP (cGMP). This increase in cGMP isbelieved to cause a decrease in water and sodium absorption and anincrease in chloride and potassium ion secretion, leading to changes inintestinal fluid and electrolyte transport and increased intestinalmotility. The intestinal GC-C receptor possesses an extracellular ligandbinding region, a transmembrane region, an intracellular proteinkinase-like region and a cyclase catalytic domain. Proposed functionsfor the GC-C receptor are fluid and electrolyte homeostasis, theregulation of epithelial cell proliferation and the induction ofapoptosis (Shalubhai 2002 Curr Opin Drug Dis Devel 5:261-268).

In addition to being expressed in the intestine by gastrointestinalepithelial cells, GC-C is expressed in extra-intestinal tissuesincluding kidney, lung, pancreas, pituitary, adrenal, developing liverand gall bladder (reviewed in Vaandrager 2002 Mol Cell Biochem230:73-83, Kulaksiz et al. 2004, Gastroenterology 126:732-740) and maleand female reproductive tissues (reviewed in Vaandrager 2002 Mol CellBiochem 230:73-83). This suggests that the GC-C receptor agonists can beused in the treatment of disorders outside the GI tract, for example,congestive heart failure and benign prostatic hyperplasia.

Ghrelin, a peptide hormone secreted by the stomach, is a key regulatorof appetite in humans. Ghrelin expression levels are regulated byfasting and by gastric emptying (Kim et al. 2003 Neuroreprt 14:1317-20;Gualillo et al. 2003 FEBS Letts 552: 105-9). Thus, by increasinggastrointestinal motility, GC-C receptor agonists may also be used toregulate obesity.

In humans, the GC-C receptor is activated by guanylin (Gn) (U.S. Pat.No. 5,96,097), uroguanylin (Ugn) (U.S. Pat. No. 5,140,102) andlymphoguanylin (Forte et al. 1999 Endocrinology 140:1800-1806).Interestingly, these agents are 10-100 fold less potent than a class ofbacterially derived peptides, termed ST (reviewed in Gianella 1995 J LabClin Med 125:173-181). ST peptides are considered super agonists of GC-Cand are very resistant to proteolytic degradation.

ST peptide is capable of stimulating the enteric nervous system (Rolfeet al., 1994, J Physiolo 475: 531-537; Rolfe et al. 1999 Gut 44:615-619; Nzegwu et al. 1996 Exp Physiol 81: 313-315). Also, cGMP hasbeen reported to have antinociceptive effects in multiple animal modelsof pain (Lazaro Ibanez et al. 2001 Eur J Pharmacol 426: 39-44; Soares etal. 2001 British J Pharmacol 134: 127-131; Jain et al. 2001 Brain Res909:170-178; Amarante et al. 2002 Eur J Pharmacol 454:19-23). Thus, GC-Cagonists may have both an analgesic as well an anti-inflammatory effect.

In bacteria, ST peptides are derived from a preproprotein that generallyhas at least 70 amino acids. The pre and pro regions are cleaved as partof the secretion process, and the resulting mature protein, whichgenerally includes fewer than 20 amino acids, is biologically active.

Among the known bacterial ST peptides are: E. coli ST Ib (Moseley et al.1983 Infect. Immun. 39:1167) having the mature amino acid sequence AsnSer Ser Asn Tyr Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr(SEQ ID NO:_); E. coli ST Ia (So and McCarthy 1980 Proc. Natl. Acad.Sci. USA 77:4011) having the mature amino acid sequence Asn Thr Phe TyrCys Cys Glu Leu Cys Cys Asn Pro Ala Cys Ala Gly Cys Tyr (SEQ ID NO:_);E. coli ST I* (Chan and Giannella 1981 J. Biol. Chem. 256:7744) havingthe mature amino acid sequence Asn Thr Phe Tyr Cys Cys Glu Leu Cys CysTyr Pro Ala Cys Ala Gly Cys Asn (SEQ ID NO:_); C. freundii ST peptide(Guarino et al. 1989b Infect. Immun. 57:649) having the mature aminoacid sequence Asn Thr Phe Tyr Cys Cys Glu Leu Cys Cys Asn Pro Ala CysAla Gly Cys Tyr (SEQ ID NO:_); Y. enterocolitica ST peptides,Y-ST(Y-STa), Y-STb, and Y-STc (reviewed in Huang et al. 1997 Microb.Pathog. 22:89) having the following pro-form amino acid sequences: GlnAla Cys Asp Pro Pro Ser Pro Pro Ala Glu Val Ser Ser Asp Trp Asp Cys CysAsp Val Cys Cys Asn Pro Ala Cys Ala Gly Cys (SEQ ID NO:_) (as well as aSer-7 to Leu-7 variant of Y-STa (SEQ ID NO:_), (Takao et al. 1985 Eur.J. Biochem. 152:199)); Lys Ala Cys Asp Thr Gln Thr Pro Ser Pro Ser GluGlu Asn Asp Asp Trp Cys Cys Glu Val Cys Cys Asn Pro Ala Cys Ala Gly Cys(SEQ ID NO:_); Gln Glu Thr Ala Ser Gly Gln Val Gly Asp Val Ser Ser SerThr Ile Ala Thr Glu Val Ser Glu Ala Glu Cys Gly Thr Gln Ser Ala Thr ThrGln Gly Glu Asn Asp Trp Asp Trp Cys Cys Glu Leu Cys Cys Asn Pro Ala CysPhe Gly Cys (SEQ ID NO:_), respectively; Y. kristensenii ST peptidehaving the mature amino acid sequence Ser Asp Trp Cys Cys Glu Val CysCys Asn Pro Ala Cys Ala Gly Cys (SEQ ID NO:_); V. cholerae non-01 STpeptide (Takao et al. (1985) FEBS lett. 193:250) having the mature aminoacid sequence Ile Asp Cys Cys Glu Ile Cys Cys Asn Pro Ala Cys Phe GlyCys Leu Asn (SEQ ID NO:_); and V. mimicus ST peptide (Arita et al. 1991FEMS Microbiol. Lett. 79:105) having the mature amino acid sequence IleAsp Cys Cys Glu Ile Cys Cys Asn Pro Ala Cys Phe Gly Cys Leu Asn (SEQ IDNO:_). Table I below provides sequences of all or a portion of a numberof mature ST peptides. Such peptides are useful GCC agonists.

TABLE 1 GenBank ® Accession GenBank ® No. GI No. Sequence QHECIB 69638NSSNYCCELCCNPACTGCY (SEQ ID NO:_) P01559 123711 NTFYCCELCCNPACAGCY (SEQID NO:_) AAA24653 147878 NTFYCCELCCNPACAPCY (SEQ ID NO:_) P01560 123707NTFYCCELCCYPACAGCN (SEQ ID NO:_) AAA27561 295439 IDCCEICCNPACFGCLN (SEQID NO:_) P04429 123712 IDCCEICCNPACFGCLN (SEQ ID NO:_) S34671 421286IDCCEICCNPACF (SEQ ID NO:_) CAA52209 395161 IDCCEICCNPACFG (SEQ ID NO:_)A54534 628844 IDCCEICCNPACFGCLN (SEQ ID NO:_) AAL02159 15592919IDRCEICCNPACFGCLN (SEQ ID NO:_) AAA18472 487395 DWDCCDVCCNPACAGC (SEQ IDNO:_) S25659 282047 DWDCCDVCCNPACAGC (SEQ ID NO:_) P74977 3913874NDDWCCEVCCNPACAGC (SEQ ID NO:_) BAA23656 2662339 WDWCCELCCNPACFGC (SEQID NO:_) P31518 399947 SDWCCEVCCNPACAGC (SEQ ID NO:_)QACDPPSPPAEVSSDWDCCDVCCDPAC AGC QACDPPSPPAEVSSDWDCCDVCCNPACAG CKACDTQTPSPSEENDDTCCEVCCNPACAG C QETASGQVGDVSSSTIATEVSEAECGTQSATTQGENDWDWCCELCCNPACFGC MKKLMLAIFISVLSFPSFSQSTESLDSSKEKITLETKKCDVVKNNSEKKSEN MNNTFYCCELCCNPACAGCYMKKSILFIFLSVLSFSPFAQDAKPVE SSKEKITLESKKCNIAKKSNKSGPESMNSSNYCCELCCNPACTGCY MKKIVFVLVLMLSSFGAFGQETVSGQFSDALSTPITAEVYKQACDPPLPPAA AEVSSDWDCCDVCCNPACAGC GNLIDCCEICCNPACFGCLNGNLIDRCEICCNPACFGCLN PPAEVSSDWDCCDVCCNPACAGCThe immature (including pre and pro regions) form of E. coli ST-1 A(ST-P) protein has the sequence:mkklmlaifisvlsfpsfsqstesldsskekitletkkcdvvknnsekksennmnntfyccelccnpacagcy(SEQ ID NO:_; see GenBank® Accession No. P01559 (gi:123711). The presequence extends from aa 1-19. The pro sequence extends from aa 20-54.The mature protein extends from 55-72. The immature (including pre andpro regions) form of E. coli ST-LB (ST-H) protein has the sequence:mkksilfiflsvlsfspfaqdakpvesskekitleskkcniakksnksgpesmnssnyccelccnpactgcy(SEQ ID NO:_; see GenBank® Accession No. P07965 (gi:3915589)). Theimmature (including pre and pro regions) form of Y. enterocolitica STprotein has the sequence:mkkivfvlylmlssfgafgqetvsgqfsdalstpitaevykqacdpplppaevssdwdccdvccnpacagc(SEQ ID NO:_; see GenBanke Accession No. S25659 (gi:282047)).

The peptides of the invention, like the bacterial ST peptides, have sixCys residues. These six Cys residues form three disulfide bonds in themature and active form of the peptide. If the six Cys residues areidentified, from the amino to carboxy terminus of the peptide, as A, B,C, D, E, and F, then the disulfide bonds form as follows: A-D, B-E, andC—F. The formation of these bonds is thought to be important for GC-Creceptor binding. Certain of the peptides of the invention include apotentially functional chymotrypsin cleavage site, e.g., a Trp, Tyr orPhe located between either Cys B and Cys D or between Cys E and Cys F.Cleavage at either chymotrypsin cleavage site may reduce or eliminatesthe ability of the peptide to bind to the GC-C receptor.

In the human body an inactive form of chymotrypsin, chymotrypsinogen isproduced in the pancreas. When this inactive enzyme reaches the smallintestine it is converted to active chymotrypsin by the excision of twodi-peptides. Active chymotrypsin can potentially cleave peptides at thepeptide bond on the carboxy-terminal side of Trp, Tyr or Phe. Thepresence of active chymotrypsin in the intestinal tract can potentiallylead to cleavage of certain of the peptides of the invention having anappropriately positioned functional chymotrypsin cleavage site. It isexpected that chymotrypsin cleavage will moderate the action of apeptide of the invention having an appropriately positioned chymotrypsincleavage site as the peptide passes through the intestinal tract.

Trypsinogen, like chymotrypsin, is a serine protease that is produced inthe pancreas and is present in the digestive tract. The active form,trypsin, will cleave peptides having a Lys or Arg. The presence ofactive trypsin in the intestinal tract can lead to cleavage of certainof the peptides of the invention having an appropriately positionedfunctional trypsin cleavage site. It is expected that chymotrypsincleavage will moderate the action of a peptide of the invention havingan appropriately positioned trypsin cleavage site as the peptide passesthrough the intestinal tract.

Many gastrointestinal disorders, including IBS, are associated withabdominal or visceral pain. Certain of the peptides of the inventioninclude analgesic or antinociceptive tags such as the carboxy-terminalsequence AspPhe immediately following a Trp, Tyr or Phe that creates afunctional chymotrypsin cleavage site or following Lys or Arg thatcreates a functional trypsin cleavage site. Chymotrypsin in theintestinal tract can potentially cleave such peptides immediatelycarboxy terminal to the Trp, Phe or Tyr residue, releasing thedipeptide, AspPhe. This dipeptide has been shown to have analgesicactivity in animal models (Abdikkahi et al. 2001 Fundam Clin Pharmacol15:117-23; Nikfar et al 1997, 29:583-6; Edmundson et al 1998 ClinPharmacol Ther 63:580-93). In this manner such peptides can treat bothpain and inflammation. Other analgesic peptides can be present at theamino or carboxy terminus of the peptide (e.g., following a functionalcleavage site) including: endomorphin-1, endomorphin-2, nocistatin,dalargin, lupron, and substance P.

A number of the useful peptides are based on the core sequence: Cys CysGlu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr. To create a varianthaving a potentially functional chymotrypsin cleavage site capable ofinactivating the peptide, either the Leu (underlined) or the Thr(underlined) can be replaced by Trp, Phe or Tyr or both the Leu and theThr can be replaced by (independently) Trp, Phe or Tyr. To create avariant having an analgesic di-peptide, the core sequence is followed byAsp Phe. The carboxy terminal Tyr in the core sequence can allow the AspPhe dipeptide to be released by chymotrypsin in the digestive tract. Thecore sequence can be optionally be preceded by Asn Ser Ser Asn Tyr orAsn.

Thus, useful variants based on the core sequence include:

(SEQ ID NO:4) Asn Ser Ser Asn Tyr Cys Cys Glu Leu Cys Cys Asn Pro AlaCys Thr Gly Cys Tyr (SEQ ID NO:---) Asn Ser Ser Asn Tyr Cys Cys Glu LeuCys Cys Asn Pro Ala Cys Trp Gly Cys Tyr (SEQ ID NO:5) Asn Ser Ser AsnTyr Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ IDNO:6) Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ IDNO:---) Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Trp Gly Cys Tyr (SEQ IDNO:3) Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ IDNO:---) Asn Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQID NO:---) Asn Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Trp Gly Cys Tyr(SEQ ID NO:---) Asn Cys Cys Glu Phe Cys Cys Asn Pro Ala Cys Thr Gly CysTyr (SEQ ID NO:---) Asn Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr GlyCys Tyr (SEQ ID NO:---) Asn Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys ThrGly Cys Tyr (SEQ ID NO:---) Asn Cys Cys Glu Arg Cys Cys Asn Pro Ala CysThr Gly Cys Tyr (SEQ ID NO:---) Asn Cys Cys Glu Lys Cys Cys Asn Pro AlaCys Thr Gly Cys Tyr (SEQ ID NO:---) Asn Ser Ser Asn Tyr Cys Cys Glu LeuCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Asp Phe (SEQ ID NO:---) Asn SerSer Asn Tyr Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Trp Gly Cys Tyr AspPhe (SEQ ID NO:---) Asn Ser Ser Asn Tyr Cys Cys Glu Phe Cys Cys Asn ProAla Cys Thr Gly Cys Tyr Asp Phe (SEQ ID NO:---) Asn Ser Ser Asn Tyr CysCys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Asp Phe (SEQ IDNO:---) Asn Ser Ser Asn Tyr Cys Cys Glu Trp Cys Cys Asn Pro Ala Cys ThrGly Cys Tyr Asp Phe (SEQ ID NO:---) Asn Ser Ser Asn Tyr Cys Cys Glu ArgCys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Asp Phe (SEQ ID NO:---) Asn SerSer Asn Tyr Cys Cys Glu Lys Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr AspPhe (SEQ ID NO:---) Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly CysTyr Asp Phe (SEQ ID NO:---) Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys TrpGly Cys Tyr Asp Phe (SEQ ID NO:---) Cys Cys Glu Phe Cys Cys Asn Pro AlaCys Thr Gly Cys Tyr Asp Phe (SEQ ID NO:---) Cys Cys Glu Tyr Cys Cys AsnPro Ala Cys Thr Gly Cys Tyr Asp Phe (SEQ ID NO:---) Cys Cys Glu Trp CysCys Asn Pro Ala Cys Thr Gly Cys Tyr Asp Phe (SEQ ID NO:---) Cys Cys GluArg Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Asp Phe (SEQ ID NO:---) CysCys Glu Lys Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Asp Phe (SEQ IDNO:---) Asn Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr AspPhe (SEQ ID NO:---) Asn Cys Cys Glu Leu Cys Cys Asn Pro Ala Cys Trp GlyCys Tyr Asp Phe (SEQ ID NO:---) Asn Cys Cys Glu Phe Cys Cys Asn Pro AlaCys Thr Gly Cys Tyr Asp Phe (SEQ ID NO:---) Asn Cys Cys Glu Tyr Cys CysAsn Pro Ala Cys Thr Gly Cys Tyr Asp Phe (SEQ ID NO:---) Asn Cys Cys GluTrp Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Asp Phe (SEQ ID NO:---) AsnCys Cys Glu Arg Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr Asp Phe (SEQ IDNO:---) Asn Cys Cys Glu Lys Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr AspPhe

In some cases, the peptides of the invention are produced as a preproprotein that includes the amino terminal leader sequence:mkksilfiflsvlsfspfaqdakpvesskekitleskkcniakksnksgpesmn. Where thepeptide is produced by a bacterial cell, e.g., E. Coli, the forgoingleader sequence will be cleaved and the mature peptide will beefficiently secreted from the bacterial cell. U.S. Pat. No. 5,395,490describes vectors, expression systems and methods for the efficientproduction of ST peptides in bacterial cells and methods for achievingefficient secretion of mature ST peptides. The vectors, expressionsystems and methods described in U.S. Pat. No. 5,395,490 can be used toproduce the ST peptides and variant ST peptides of the present invention

Variant Peptides

The invention includes variant peptides which can include one, two,three, four, five, six, seven, eight, nine, or ten (in some embodimentsfewer than 5 or fewer than 3 or 2 or fewer) amino acid substitutionsand/or deletions compared to SEQ ID NOs:_to _. The substitution(s) canbe conservative or non-conservative. The naturally-occurring amino acidscan be substituted by D-isomers of any amino acid, non-natural aminoacids, natural and natural amino acid analogs and other groups. Aconservative amino acid substitution results in the alteration of anamino acid for a similar acting amino acid, or amino acid of likecharge, polarity, or hydrophobicity. At some positions, evenconservative amino acid substitutions can alter the activity of thepeptide. A conservative substitution can substitute anaturally-occurring amino acid for a non-naturally-occurring amino acid.The amino acid substitutions among naturally-occurring amino acids arelisted in Table II.

TABLE II For Amino Acid Code Replace with any of Alanine Ala Gly, Cys,Ser Arginine Arg Lys, His Asparagine Asn Asp, Glu, Gln, Aspartic AcidAsp Asn, Glu, Gln Cysteine Cys Met, Thr, Ser Glutamine Gln Asn, Glu, AspGlutamic Acid Glu Asp, Asn, Gln Glycine Gly Ala Histidine His Lys, ArgIsoleucine Ile Val, Leu, Met Leucine Leu Vai, Ile, Met Lysine Lys Arg,His Methionine Met Ile, Leu, Val Phenylalanine Phe Tyr, His, Trp ProlinePro Serine Ser Thr, Cys, Ala Threonine Thr Ser, Met, Val Tryptophan TrpPhe, Tyr Tyrosine Tyr Phe, His Valine Val Leu, Ile, Met

In some circumstances it can be desirable to treat patients with avariant peptide that binds to and activates intestinal GC-C receptor,but is less active than the non-variant form the peptide. This reducedactivity can arise from reduced affinity for the receptor or a reducedability to activate the receptor once bound or reduced stability of thepeptide.

Production of peptides

Useful peptides can be produced either in bacteria including, withoutlimitation, E. coli, or in other existing systems for peptide or proteinproduction (e.g., Bacillus subtilis, baculovirus expression systemsusing Drosophila Sf9 cells, yeast or filamentous fungal expressionsystems, mammalian cell expression systems), or they can be chemicallysynthesized.

If the peptide or variant peptide is to be produced in bacteria, e.g.,E. coli, the nucleic acid molecule encoding the peptide will preferablyalso encode a leader sequence that permits the secretion of the maturepeptide from the cell. Thus, the sequence encoding the peptide caninclude the pre sequence and the pro sequence of, for example, anaturally-occurring bacterial ST peptide. The secreted, mature peptidecan be purified from the culture medium.

The sequence encoding a peptide of the invention is preferably insertedinto a vector capable of delivering and maintaining the nucleic acidmolecule in a bacterial cell. The DNA molecule may be inserted into anautonomously replicating vector (suitable vectors include, for example,pGEM3Z and pcDNA3, and derivatives thereof). The vector nucleic acid maybe a bacterial or bacteriophage DNA such as bacteriophage lambda or M13and derivatives thereof. Construction of a vector containing a nucleicacid described herein can be followed by transformation of a host cellsuch as a bacterium. Suitable bacterial hosts include but are notlimited to, E. coli, B. subtilis, Pseudomonas, Salmonella. The geneticconstruct also includes, in addition to the encoding nucleic acidmolecule, elements that allow expression, such as a promoter andregulatory sequences. The expression vectors may contain transcriptionalcontrol sequences that control transcriptional initiation, such aspromoter, enhancer, operator, and repressor sequences. A variety oftranscriptional control sequences are well known to those in the art.The expression vector can also include a translation regulatory sequence(e.g., an untranslated 5′ sequence, an untranslated 3′ sequence, or aninternal ribosome entry site). The vector can be capable of autonomousreplication or it can integrate into host DNA to ensure stability duringpeptide production.

The protein coding sequence that includes a peptide of the invention canalso be fused to a nucleic acid encoding a polypeptide affinity tag,e.g., glutathione S-transferase (GST), maltose E binding protein,protein A, FLAG tag, hexa-histidine, myc tag or the influenza HA tag, inorder to facilitate purification. The affinity tag or reporter fusionjoins the reading frame of the peptide of interest to the reading frameof the gene encoding the affinity tag such that a translational fusionis generated. Expression of the fusion gene results in translation of asingle polypeptide that includes both the peptide of interest and theaffinity tag. In some instances where affinity tags are utilized, DNAsequence encoding a protease recognition site will be fused between thereading frames for the affinity tag and the peptide of interest.

Genetic constructs and methods suitable for production of immature andmature forms of the peptides and variants of the invention in proteinexpression systems other than bacteria, and well known to those skilledin the art, can also be used to produce peptides in a biological system.

Mature peptides and variants thereof can be synthesized by thesolid-phase chemical synthesis. For example, the peptide can besynthesized on Cyc(4-CH₂ Bxl)-OCH₂-4-(oxymethyl)-phenylacetamidomethylresin using a double coupling program. Protecting groups must be usedappropriately to create the correct disulfide bond pattern. For example,the following protecting groups can be used: t-butyloxycarbonyl(alpha-amino groups); acetamidomethyl (thiol groups of Cys residues Band E); 4-methylbenzyl (thiol groups of Cys residues C and F); benzyl(y-carboxyl of glutamic acid and the hydroxyl group of threonine, ifpresent); and bromobenzyl (phenolic group of tyrosine, if present).Coupling is effected with symmetrical anhydride oft-butoxylcarbonylamino acids or hydroxybenzotriazole ester (forasparagine or glutamine residues), and the peptide is deprotected andcleaved from the solid support in hydrogen fluoride, dimethyl sulfide,anisole, and p-thiocresol using 8/1/1/0.5 ratio (v/v/v/w) at 0° C. for60 min. After removal of hydrogen fluoride and dimethyl sulfide byreduced pressure and anisole and p-thiocresol by extraction with ethylether and ethyl acetate sequentially, crude peptides are extracted witha mixture of 0.5M sodium phosphate buffer, pH 8.0 andN,N-dimethylformamide using 1/1 ratio, v/v. The disulfide bond for Cysresidues B and E is the formed using dimethyl sulfoxide (Tam et al.(1991) J. Am. Chem. Soc. 113:6657-62). The resulting peptide is thepurified by reverse-phase chromatography. The disulfide bond between Cysresidues C and F is formed by first dissolving the peptide in 50% aceticacid in water. Saturated iodine solution in glacial acetic acid is added(1 ml iodine solution per 100 ml solution). After incubation at roomtemperature for 2 days in an enclosed glass container, the solution isdiluted five-fold with deionized water and extracted with ethyl etherfour times for removal of unreacted iodine. After removal of theresidual amount of ethyl ether by rotary evaporation the solution ofcrude product is lyophilized and purified by successive reverse-phasechromatography.

Peptides can also be synthesized by many other methods including solidphase synthesis using traditional FMOC protection (i.e., coupling withDCC-HOBt and deprotection with piperidine in DMF). Cys thiol groups canbe trityl protected. Treatment with TFA can be used for finaldeprotection of the peptide and release of the peptide from thesolid-state resin. In many cases air oxidation is sufficient to achieveproper disulfide bond formation.

Intestinal GC-C Receptor Binding Assay

The ability of peptides and other agents to bind to the intestinal GC-Creceptor can be tested as follows. Cells of the T84 human coloncarcinoma cell line (American Type Culture Collection (Bethesda, Md.))are grown to confluence in 24-well culture plates with a 1:1 mixture ofHam's F12 medium and Dulbecco's modified Eagle's medium (DMEM),supplemented with 5% fetal calf serum. Cells used in the assay aretypically between passages 54-60. Briefly, T84 cell monolayers in24-well plates are washed twice with 1 ml of binding buffer (DMEMcontaining 0.05% bovine serum albumin and 25 mM HEPES, pH 7.2), thenincubated for 30 min at 37° C. in the presence of mature radioactivelylabeled E. coli ST peptide and the test material at variousconcentrations. The cells are then washed four times with 1 ml of DMEMand solubilized with 0.5 ml/well 1N NaOH. The level of radioactivity inthe solubilized material is then determined using standard methods.

EXAMPLE 1 Preparation of Variant ST Peptides and Wild-Type ST Peptide1a: Preparation of Recombinant Variant ST Peptides and Wild-Type STPeptide

A variant ST peptide having the sequence Asn Ser Ser Asn Tyr Cys Cys GluTyr Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO:5) was producedrecombinantly and tested in an animal model. A peptide having thesequence of the wild-type ST peptide was also created (SEQ ID NO:4).

SEQ ID NO:5 and SEQ ID NO:4 peptides were produced as preproproteinsusing vectors produced as follows. A sequence encoding a heat-stableenterotoxin pre-pro sequence was amplified from pGK51/pGSK51 (ATCC67728) using oligonucleotide MO3514 (5′CACACCATATGAAGAAATCAATATTATTTATTTTTCTTTCTG 3′ (SEG ID NO:)) andoligonucleotide MO3515 (5′CACACCTCGAGTTAGGTCTCCATGCTTTCAGGACCACTTTTATTAC 3′ (SEQ ID NO: _)). Theamplification product fragment was digested with NdeI/XhoI and ligatedto the T7 expression vector, pET26b(+) (Novagen) digested with NdeI/XhoIthereby creating plasmid MB3976. The region encoding the pre-pro proteinwas sequenced and found to encode the amino acid sequence:mkksilfiflsvlsfspfaqdakpagsskekitleskkcnivkksnksgpesm (SEQ ID NO:_)which differs from the amino acid sequence of heat-stable enterotoxin a2precursor (sta2; mkksilfiflsvlsfspfaqdakpagsskekitleskkcnivkknnesspesm(SEQ ID NO:_); GenBank® Accession No. Q47185, GI: 3913876) at threepositions (indicated by underlining and bold text) near the C-terminus.To create expression vectors with the pre-pro sequence, complementaryoligos encoding each ST peptide variant or wild-type ST peptide wereannealed and cloned into the MB3976 expression vector. To create MB3984(encoding SEQ ID NO:4 peptide (wild-type ST peptide) as a preproprotein), containing the amino acid sequence, NSSNYCCELCCNPACTGCY (SEQID NO:_) fused downstream of the pre-pro sequence, MB 3976 was digestedwith BsaI/XhoI and ligated to annealed oligos MO3621 (5′GCATGAATAGTAGCAATTACTGCTGTGAATTGTGTTGTAATCCTGCTTGTACCGGGT GCTATTAATAAC3′ (SEQ ID NO:_) and MO3622 (5′TCGAGTTATTAATAGCACCCGGTACAAGCAGGATTACAACACAATTCACAGCAGTA ATTGCTACTATTC3′ (SEQ ID NO:_). To create MB3985 (encoding SEQ ID NO:5 as a preproprotein) containing the following amino acid sequence,NSSNYCCEYCCNPACTGCY fused downstream of the pre-pro sequence, MB 3976was digested with BsaI/XhoI and ligated to annealed oligos MO3529 (5′GCATGAATAGTAGCAATTACTGCTGTGAATATTGTTGTAATCCTGCTTGTACCGGGT GCTATTAATAAC3′ (SEQ ID NO:_) and MO3530 (5′TCGAGTTATTAATAGCACCCGGTACAAGCAGGATTACAACAATATTCACAGCAGTA ATTGCTACTATTC3′ (SEQ ID NO:_)).

The SEQ ID NO:5 peptide and the SEQ ID NO:4 peptide were produced asfollows. The expression vectors were transformed into E. coli bacterialhost BL21λ DE3 (Invitrogen). A single colony was innoculated and grownshaking overnight at 30° C. in L broth+25 mg/l kanamycin. The overnightculture was added to 3.2 L of batch medium (Glucose 25 g/l, CaseaminoAcids 5 g/l, Yeast Extract 5 g/l, KH₂PO₄ 13.3 g/l, (NH₄)₂HPO₄ 4 g/l,MgSO₄-7H₂0 1.2 g/l, Citric Acid 1.7 g/l, EDTA 8.4 mg/l, CoCl₂-6H₂O 2.5mg/l, MnCl₂-4H₂O 15 mg/l, CuCl₂-4H₂O 1.5 mg/l, H₃BO₃ 3 mg/l,Na₂MoO₄-2H₂0 2.5 mg/l, Zn Acetate-2H₂0 13 mg/l, Ferric Citrate 100 mg/l,Kanamycin 25 mg/l, Antifoam DF₂0₄ 1 ml/l) and fermented using thefollowing process parameters: pH 6.7—control with base only (28% NH₄OH),30° C., aeration: 5 liters per minute. After the initial consumption ofbatch glucose (based on monitoring dissolved oxygen (DO) levels), 1.5 Lof feed medium (Glucose 700 g/l, Caseamino Acids 10 g/l, Yeast Extract10 g/l, MgSO₄-7H₂0 4 g/l, EDTA 13 mg/l, CoCl₂-6H₂O 4 mg/l, MnCl₂-4H₂O23.5 mg/l, CuCl₂-4H₂0 2.5 mg/l, H₃BO₃ 5 mg/l, Na₂MoO₄-2H₂0 4 mg/l, ZnAcetate-2H₂0 16 mg/l, Ferric Citrate 40 mg/l, Antifoam DF₂0₄ 1 ml/l) wasadded at a feed rate controlled to maintain 20% DO. IPTG was added to0.2 mM 2 hours post feed start. The total run time was approximately40-45 hours (until feed exhaustion).

Cells were collected by centrifugation at 5,000 g for 10 minutes. Thecell pellet was discarded and the supernatant was passed through a 50 Kdultrafiltration unit. The 50 Kd filtrate (0.6 liters) was loaded onto a110 ml Q-Sepharose fast Flow column (Amersham Pharmacia, equilibratedwith 20 mM Tris-HCl pH 7.5) at a flow rate of 400 ml/hour. The columnwas washed with six volumes of 20 mM Tris-HCl pH 7.5 and proteins wereeluted with 50 mM acetic acid collecting 50 ml fractions. Fractionscontaining ST peptide variant or wild-type ST peptide were pooled andthe solvent was removed by rotary evaporation. The dried proteins wereresuspended in 10 ml of 8% acetic acid, 0.1% trifluoroacetic acid (TFA)and loaded onto a Varian Polaris C18-A column (250×21.2 mm 10 μm,equilibrated in the same buffer) at a flow rate of 20 ml/min. The columnwas washed with 100 ml of 8% methanol, 0.1% TFA and developed with agradient (300 ml) of 24 to 48% methanol, 0.1% TFA, collecting 5-mlfractions. Fractions containing peptide were pooled and the solvent wasremoved by rotary evaporation. The peptides were dissolved in 0.1% TFAand lyophilized.

The SEQ ID NO:5 peptide and SEQ ID NO:4 peptide fractions were analyzedby standard LCMS and HPLC. LCMS analysis revealed that SEQ ID NO:5peptide is more homogeneous than SEQ ID NO: 4 peptide (see FIG. 1 a;note that SEQ ID NO:5 peptide exhibits fewer peaks (Panel B) than SEQ IDNO:4 peptide (Panel A)).

1b: Preparation of Synthetic Variant ST Peptides and Wild-Type STPeptide

Peptides were chemically synthesized by a commercial peptide synthesiscompany. Varying yields of peptides were obtained depending on theefficiency of chemical synthesis. Thus, the four peptides, in decreasingorder of yield were: Cys Cys Glu Tyr Cys Cys Asn Pro Ala Cys Thr Gly CysTyr (SEQ ID NO:3), 10-20% yield; Cys Cys Glu Leu Cys Cys Asn Pro Ala CysThr Gly Cys Tyr (SEQ ID NO:6); Asn Ser Ser Asn Tyr Cys Cys Glu Tyr CysCys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO:5); Asn Ser Ser Asn TyrCys Cys Glu Leu Cys Cys Asn Pro Ala Cys Thr Gly Cys Tyr (SEQ ID NO:SEQID NO:4), <5% yield. Thus the specific amino acid changes introducedinto the peptides can create improved manufacturing properties.

FIG. 1 b shows the total ion chromatograph profile of syntheticallymanufactured SEQ ID NO:3 peptide. FIG. 1 c shows the total ionchromatograph profile of the control blank sample. There is one majorpeak present in the SEQ ID NO:3 peptide sample that is not also presentin the control sample. Quantitative analysis suggests the SEQ ID NO:3peptide is >98% pure.

EXAMPLE 2 Activation of the Intestinal GC-C Receptor by a Variant STPeptide and ST Peptide

The ability of SEQ ID NO:5, SEQ ID NO:4, and SEQ ID NO:3 to activate theintestinal GC-C receptor was assessed in an assay employing the T84human colon carcinoma cell line (American Type Culture Collection(Bethesda, Md.)). For the assays cells were grown to confluency in24-well culture plates with a 1:1 mixture of Ham's F12 medium andDulbecco's modified Eagle's medium (DMEM), supplemented with 5% fetalcalf serum and were used at between passages 54 and 60.

Briefly, monolayers of T84 cells in 24-well plates were washed twicewith 1 ml/well DMEM, then incubated at 37° C. for 10 min with 0.45 mlDMEM containing 1 mM isobutylmethylxanthine (IBMX), a cyclic nucleotidephosphodiesterase inhibitor. Test peptides (50 μl) were then added andincubated for 30 minutes at 37° C. The media was aspirated and thereaction was then terminated by the addition of ice cold 0.5 ml of 0.1NHCl. The samples were held on ice for 20 minutes and then evaporated todryness using a heat gun or vacuum centrifugation. The dried sampleswere resuspended in 0.5 ml of phosphate buffer provided in the CaymanChemical Cyclic GMP EIA kit (Cayman Chemical, Ann Arbor, Mich.). CyclicGMP was measured by EIA according to procedures outlined in the CaymanChemical Cyclic GMP EIA kit.

FIG. 2 shows the activity of chemically synthesized peptide variants inthis GC-C receptor activity assay. In this assay, SEQ ID NO:4 and twodifferent SEQ ID NO:3 peptides (SEQ ID NO:3(a) and SEQ ID NO:3(b),synthesized by two different methods) had activity comparable to SEQ IDNO:4. SEQ ID NO:5 and SEQ ID NO:4 peptide were chemically synthesized ina manner identical to that of SEQ ID NO:3(b).

EXAMPLE 3 SEQ ID NO:5 and SEQ ID NO:4 Increase Intestinal Transit inMice

In order to determine whether the peptides increase the rate ofgastrointestinal transit, the peptides and controls were tested using amurine gastrointestinal transit (GIT) assay (Moon et al. Infection andImmunity 25:127, 1979). In this assay, charcoal, which can be readilyvisualized in the gastrointestinal tract is administered to mice afterthe administration of a test compound. The distance traveled by thecharcoal is measured and expressed as a percentage of the total lengthof the colon.

Mice were fasted with free access to water for 12 to 16 hours before thetreatment with peptide or control buffer. The peptides were orallyadministered at 1 μg/kg-1 mg/kg of peptide in buffer (20 mM Tris pH 7.5)7 minutes before being given an oral dose of 5% Activated Carbon(Aldrich 242276-250G). Control mice were administered buffer only beforebeing given a dose of Activated Carbon. After 15 minutes, the mice weresacrificed and their intestines from the stomach to the cecum weredissected. The total length of the intestine as well as the distancetraveled from the stomach to the charcoal front was measured for eachanimal and the results are expressed as the percent of the total lengthof the intestine traveled by the charcoal front. All results arereported as the average of 10 mice±standard deviation. A comparison ofthe distance traveled by the charcoal between the mice treated withpeptide versus the mice treated with vehicle alone was performed using aStudent's t test and a statistically significant difference wasconsidered for P<0.05. P-values are calculated using a two-sided T-Testassuming unequal variances.

As can be seen in FIG. 3 a and FIG. 3 b, wild-type ST peptide (SEQ IDNO:4, (Sigma-Aldrich, St Louis, Mo.); 0.1 mg/kg), syntheticallymanufactured SEQ ID NO:3 and Zelnorm® (0.1 mg/kg), a drug approved forIBS that is an agonist for the serotonin receptor 5HT4, increasegastrointestinal transit rate in this model. FIG. 4 a shows the resultof a study demonstrating that intestinal transit rate increases with anincreasing dosage of either recombinantly synthesized SEQ ID NO:4 or SEQID NO:5. FIG. 4 b shows the results of a study demonstrating bothchemically synthesized SEQ ID NO:4 or SEQ ID NO:3 peptide increaseintestinal transit rates more than either Tris buffer alone or anequivalent dose of Zelnorm®.

The identical experiment was performed to determine if SEQ ID NO:3 iseffective in a chronic dosing treatment regimen. Briefly, 8 week old CD1female mice are dosed orally once a day for 5 days with either SEQ IDNO:3 (0.06 mg/kg or 0.25 mg/kg in 20 mM Tris pH 7.5) or vehicle alone(20 mM Tris pH 7.5). On the 5^(th) day, a GIT assay is performedidentical to that above except 200 μl of a 10% charcoal solution isadministered. FIG. 4 c shows the results of a study demonstrating bothchemically synthesized SEQ ID NO:3 or Zelnorm® are effective in a mousegastrointestinal motility assay upon chronic dosing (daily for 5 days).The results are shown side by side with acute dosing (1 day).

EXAMPLE 4 SEQ ID NO:5 Peptide and SEQ ID NO:4 Peptide IncreaseIntestinal Secretion in Suckling Mice (SuMi Assay)

SEQ ID NO:4 peptide and SEQ ID NO:5 were tested for their ability toincrease intestinal secretion using a suckling mouse model of intestinalsecretion. In this model a test compound is administered to sucklingmice that are between 7 and 9 days old. After the mice are sacrificed,the gastrointestinal tract from the stomach to the cecum is dissected(“guts”). The remains (“carcass”) as well as the guts are weighed andthe ratio of guts to carcass weight is calculated. If the ratio is above0.09, one can conclude that the test compound increases intestinalsecretion. FIG. 5 a shows a dose response curve for wild-type ST peptide(SEQ ID NO:4) in this model. FIG. 5 b shows dose response curve for theSEQ ID NO:3 peptide in this model. These data show that wild-type STpeptide (purchased from TDT, Inc. West Chester, Pa.) and the SEQ ID NO:3peptide increase intestinal secretion. The effect of Zelnorm® was alsostudied. As can be seen from FIG. 5, Zelnorm® at 0.2 mg/kg does notincrease intestinal secretion in this model. FIG. 6 a shows a doseresponse curve for the recombinant SEQ ID NO:4 peptide described aboveand the recombinant SEQ ID NO:5 peptide described above. As can be seenfrom FIG. 6 a, both peptides increase intestinal secretion in thismodel. Similarly FIG. 6 b shows a dose response curve for chemicallysynthesized SEQ ID NO:5, SEQ ID NO:3 and SEQ ID NO:4 as well aswild-type ST peptide (purchased from Sigma-Aldrich, St Louis, Mo.).

Colonic Hyperalgesia Animal Models

Hypersensitivity to colorectal distension is common in patients with IBSand may be responsible for the major symptom of pain. Both inflammatoryand non-inflammatory animal models of visceral hyperalgesia todistension have been developed to investigate the effect of compounds onvisceral pain in IBS.

I. Trinitrobenzenesulphonic Acid (TNBS)-Induced Rectal Allodynia Model

Male Wistar rats (220-250 g) were premedicated with 0.5 mg/kg ofacepromazine injected intraperitoneally (IP) and anesthetized byintramuscular administration of 100 mg/kg of ketamine. Pairs of nichromewire electrodes (60 cm in length and 80 μm in diameter) were implantedin the striated muscle of the abdomen, 2 cm laterally from the whiteline. The free ends of electrodes were exteriorized on the back of theneck and protected by a plastic tube attached to the skin.Electromyographic (EMG) recordings were started 5 days after surgery.Electrical activity of abdominal striated muscle was recorded with anelectroencephalograph machine (Mini VIII, Alvar, Paris, France) using ashort time constant (0.03 sec.) to remove low-frequency signals (<3 Hz).

Ten days post surgical implantation, trinitrobenzenesulphonic acid(TNBS) was administered to induce rectal inflammation. TNBS (80 mg kg-1in 0.3 ml 50% ethanol) was administered intrarectally through a siliconerubber catheter introduced at 3 cm from the anus under lightdiethyl-ether anesthesia, as described (Morteau et al. 1994 Dig Dis Sci39:1239). Following TNBS administration, rats were placed in plastictunnels where they were severely limited in mobility for several daysbefore colorectal distension (CRD). Experimental compound wasadministered one hour before CRD which was performed by insertion intothe rectum, at 1 cm of the anus, a 4 cm long balloon made from a latexcondom (Gue et al, 1997 Neurogastroenterol. Motil. 9:271). The balloonwas fixed on a rigid catheter taken from an embolectomy probe (Fogarty).The catheter attached balloon was fixed at the base of the tail. Theballoon, connected to a barostat, was inflated progressively by step of15 mmHg, from 0 to 60 mmHg, each step of inflation lasting 5 min.Evaluation of rectal sensitivity, as measured by EMG, was performedbefore (1-2 days) and 3 days following rectal instillation of TNBS.

The number of spike bursts that corresponds to abdominal contractionswas determined per 5 min periods. Statistical analysis of the number ofabdominal contractions and evaluation of the dose-effects relationshipswas performed by a one way analysis of variance (ANOVA) followed by apost-hoc (Student or Dunnett tests) and regression analysis for ED50 ifappropriate.

FIG. 7 shows the results of experiment in which SEQ ID NO:3 activity wasanalyzed in the TNBS colorectal model. Significant decreases inabdominal response are observed at 0.3 μg/kg and 3 μg/kg SEQ ID NO:3.These results demonstrate that SEQ ID NO:3 reduces pain associated withcolorectal distension in this animal model.

II. Stress-Induced Hyperalgesia Model

Male Wistar Rats (200-250 g) are surgically implanted with nichrome wireelectrodes as in the TNBS model. Ten days post surgical implantation,partial restraint stress (PRS), is performed as described by Williams etal. for two hours (Williams et al. 1988 Gastroenterology 64:611).Briefly, under light anesthesia with ethyl-ether, the foreshoulders,upper forelimbs and thoracic trunk are wrapped in a confining harness ofpaper tape to restrict, but not prevent body movements. Controlsham-stress animals are anaesthetized but not wrapped. Thirty minutesbefore the end of the PRS session, the animals are administeredtest-compound or vehicle. Thirty minutes to one hour after PRScompletion, the CRD distension procedure is performed as described abovefor the TNBS model with barostat at pressures of 15, 30, 45 and 60 mmHg. Statistical analysis on the number of bursts is determined andanalyzed as in the TNBS model above.

Phenylbenzoquinone-Induced Writhing Model

The PBQ-induced writhing model can be used to assess pain controlactivity of the peptides and GC-C receptor agonists of the invention.This model is described by Siegmund et al. (1957 Proc. Soc. Exp. Bio.Med. 95:729-731). Briefly, one hour after oral dosing with a testcompound, e.g., a peptide, morphine or vehicle, 0.02% phenylbenzoquinone(PBQ) solution (12.5 mL/kg) is injected by intraperitoneal route intothe mouse. The number of stretches and writhings are recorded from the5^(th) to the 10^(th) minute after PBQ injection, and can also becounted between the 35^(th) and 40^(th) minute and between the 60^(th)and 65^(th) minute to provide a kinetic assessment. The results areexpressed as the number of stretches and writhings (mean±SEM) and thepercentage of variation of the nociceptive threshold calculated from themean value of the vehicle-treated group. The statistical significance ofany differences between the treated groups and the control group isdetermined by a Dunnett's test using the residual variance after aone-way analysis of variance (P<0.05) using SigmaStat Software.

FIGS. 8 a and 8 b show the effect of different doses of SEQ ID NO:5 andSEQ ID NO:3 in the PBQ writhing assay. Indomethacin, an NSAID(nonsteroidal anti-inflammatory drug) with known pain control activity,was used as the positive control in the assay. Significant reductions inwrithings were observed for SEQ ID NO:5 (1 mg/kg dose) and SEQ ID NO:3(2.5 mg/kg dose) compared to the vehicle control. Loss of efficacy atthe highest dose tested has also been observed for multiple othercompounds (such as 5HT-3 antagonists) tested in similar assays. Theresults of this study suggest that both SEQ ID NO:5 and SEQ ID NO:3 haveantinociceptive effects in this visceral pain model comparable to theintermediate doses of indomethacin.

EXAMPLE 5 SEQ ID NO:3 Kd Determination

To determine the affinity of SEQ ID NO:3 for GC-C receptors found in ratintestinal mucosa, a competition binding assay was performed using rateintestinal epithelial cells. Epithelial cells from the small intestineof rats were obtained as described by Kessler et al. (J. Biol. Chem.245: 5281-5288 (1970)). Briefly, animals were sacrificed and theirabdominal cavities exposed. The small intestine was rinsed with 300 mlice cold saline or PBS. 10 cm of the small intestine measured at 10 cmfrom the pylorus was removed and cut into 1 inch segments. Intestinalmucosa was extruded from the intestine by gentle pressure between apiece of parafilm and a P-1000 pipette tip. Intestinal epithelial cellswere placed in 2 ml PBS and pipetted up and down with a 5 ml pipette tomake a suspension of cells. Protein concentration in the suspension wasmeasured using the Bradford method (Anal. Biochem. 72: 248-254 (1976)).

A competition binding assay was performed based on the method ofGiannella et al. (Am. J. Physiol. 245: G492-G498) between [¹²⁵I] labeledSEQ ID NO:4 and SEQ ID NO:3. The assay mixture contained: 0.5 ml of DMEwith 20 mM HEPES-KOH pH 7.0, 0.9 mg of the cell suspension listed above,21.4 fmol [¹²⁵I]-SEQ ID NO:4 (42.8 pM), and different concentrations ofcompetitor SEQ ID NO:3 (0.01 to 1000 nM). The mixture was incubated atroom temperature for 1 hour, and the reaction stopped by applying themixture to GF/B glass-fiber filters (Whatman). The filters were washedwith 5 ml ice-cold PBS and radioactivity was measured. FIG. 9 shows thatthe Kd for SEQ ID NO:3 in this assay is 4.5 nm. % B/Bo is the percentageof the ratio of radioactivity trapped in each sample (B) compared to theradioactivity retained in a control sample with no cold competitor (Bo).Giannella et al. (Am. J. Physiol. 245: G492-G498) observed that the Kdfor wild-type ST peptide in this same assay was ˜13 nm.

EXAMPLE 6 Pharmacokinetic Properties of SEQ ID NO:3

To study the pharmacokinetics of SEQ ID NO:3, absorbability studies inmice were performed by administering SEQ ID NO:3 intravaneously via tailvein injection or orally by gavage to 8-week-old CD1 mice. Serum wascollected from the animals at various time points and tested for thepresence of SEQ ID NO:3 using a competitive enzyme-linkedimmunoabsorbent assay (Oxoid, ST EIA kit, Cat#TD0700). The assayutilized monoclonal antibodies against ST peptide (antibodies areprovided in the Oxoid kit) and synthetically manufactured SEQ ID NO:3.FIG. 10 a shows absorption data for intravenously and orallyadministered SEQ ID NO:3 as detected by the ELISA assay. SEQ ID NO:3appears to be minimally systemically absorbed and is <2.2% bioavailable.

A similar bioavailability study was performed in which LCMS rather thanELISA was used to detect SEQ ID NO:3. Initially, serum samples wereextracted from the whole blood of exposed and control mice, theninjected directly (10 mL) onto an in-line solid phase extraction (SPE)column (Waters Oasis HLB 25 mm column, 2.0×15 mm direct connect) withoutfurther processing. The sample on the SPE column was washed with a 5%methanol, 95% dH₂O solution (2.1 mL/min, 1.0 minute), then loaded ontoan analytical column using a valve switch that places the SPE column inan inverted flow path onto the analytical column (Waters Xterra MS C8 5mm IS column, 2.1×20 mm). The sample was eluted from the analyticalcolumn with a reverse phase gradient (Mobile Phase A: 10 mM ammoniumhydroxide in dH₂O, Mobile Phase B: 10 mM ammonium hydroxide in 80%acetonitrile and 20% methanol; 20% B for the first 3 minutes thenramping to 95% B over 4 min. and holding for 2 min., all at a flow rateof 0.4 mL/min.). At 9.1 minutes, the gradient returns to the initialconditions of 20% B for 1 min. SEQ ID NO:3 eluted from the analyticalcolumn at 1.45 minutes, and was detected by triple-quadrapole massspectrometry (MRM, 764 (+2 charge state)>182 (+1 charge state) Da; conevoltage=30V; collision=20 eV; parent resolution=2 Da at base peak;daughter resolution=2 Da at base peak). Instrument response wasconverted into concentration units by comparison with a standard curveusing known amounts of chemically synthesized SEQ ID NO:3 prepared andinjected in mouse serum using the same procedure.

FIG. 10 b shows absorption data for IV and orally administered SEQ IDNO:3 as detected by LCMS. In this assay, SEQ ID NO:3 appears similarlyminimally systemically absorbed and is <0.11% bioavailable.

Administration of Peptides and GC-C Receptor Agonists

For treatment of gastrointestinal disorders, the peptides and agonistsof the invention are preferably administered orally, e.g., as a tabletor cachet containing a predetermined amount of the active ingredient,pellet, gel, paste, syrup, bolus, electuary, slurry, sachet; capsule;powder; lyophilized powder; granules; as a solution or a suspension inan aqueous liquid or a non-aqueous liquid; as an oil-in-water liquidemulsion or a water-in-oil liquid emulsion, via a liposomal formulation(see, e.g., EP 736299) or in some other form. Orally administeredcompositions can include binders, lubricants, inert diluents,lubricating, surface active or dispersing agents, flavoring agents, andhumectants. Orally administered formulations such as tablets mayoptionally be coated or scored and may be formulated so as to providesustained, delayed or controlled release of the active ingredienttherein. The peptides and agonists can be co-administered with otheragents used to treat gastrointestinal disorders including but notlimited to the agents described herein. The peptides and agonists canalso be administered by rectal suppository. For the treatment ofdisorders outside the gastrointestinal tract such as congestive heartfailure and benign prostatic hypertrophy, peptides and agonists arepreferably administered parenterally or orally.

The peptides described herein can be administered alone or incombination with other agents. For example, the peptides can beadministered together with an analgesic peptide or compound. Theanalgesic peptide or compound can be covalently attached to a peptidedescribed herein or it can be a separate agent that is administeredtogether with or sequentially with a peptide described herein in acombination therapy.

Combination therapy can be achieved by administering two or more agents,e.g., a peptide described herein and an analgesic peptide or compound,each of which is formulated and administered separately, or byadministering two or more agents in a single formulation. Othercombinations are also encompassed by combination therapy. For example,two agents can be formulated together and administered in conjunctionwith a separate formulation containing a third agent. While the two ormore agents in the combination therapy can be administeredsimultaneously, they need not be. For example, administration of a firstagent (or combination of agents) can precede administration of a secondagent (or combination of agents) by minutes, hours, days, or weeks.Thus, the two or more agents can be administered within minutes of eachother or within 1, 2, 3, 6, 9, 12, 15, 18, or 24 hours of each other orwithin 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14 days of each other orwithin 2, 3, 4, 5, 6, 7, 8, 9, or 10 weeks of each other. In some caseseven longer intervals are possible. While in many cases it is desirablethat the two or more agents used in a combination therapy be present inwithin the patient's body at the same time, this need not be so.

Combination therapy can also include two or more administrations of oneor more of the agents used in the combination. For example, if agent Xand agent Y are used in a combination, one could administer themsequentially in any combination one or more times, e.g., in the orderX-Y-X, X-X-Y, Y-X-Y, Y-Y-X, X-X-Y-Y, etc.

The agents, alone or in combination, can be combined with anypharmaceutically acceptable carrier or medium. Thus, they can becombined with materials that do not produce an adverse, allergic orotherwise unwanted reaction when administered to a patient. The carriersor mediums used can include solvents, dispersants, coatings, absorptionpromoting agents, controlled release agents, and one or more inertexcipients (which include starches, polyols, granulating agents,microcrystalline cellulose, diluents, lubricants, binders,disintegrating agents, and the like), etc. If desired, tablet dosages ofthe disclosed compositions may be coated by standard aqueous ornonaqueous techniques.

Compositions of the present invention may also optionally include othertherapeutic ingredients, anti-caking agents, preservatives, sweeteningagents, colorants, flavors, desiccants, plasticizers, dyes, and thelike. Any such optional ingredient must be compatible with the compoundof the invention to insure the stability of the formulation. Thecomposition may contain other additives as needed, including for examplelactose, glucose, fructose, galactose, trehalose, sucrose, maltose,raffinose, maltitol, melezitose, stachyose, lactitol, palatinite,starch, xylitol, mannitol, myoinositol, and the like, and hydratesthereof, and amino acids, for example alanine, glycine and betaine, andpeptides and proteins, for example albumen.

Examples of excipients for use as the pharmaceutically acceptablecarriers and the pharmaceutically acceptable inert carriers and theaforementioned additional ingredients include, but are not limited tobinders, fillers, disintegrants, lubricants, anti-microbial agents, andcoating agents such as:

BINDERS: corn starch, potato starch, other starches, gelatin, naturaland synthetic gums such as acacia, sodium alginate, alginic acid, otheralginates, powdered tragacanth, guar gum, cellulose and its derivatives(e.g., ethyl cellulose, cellulose acetate, carboxymethyl cellulosecalcium, sodium carboxymethyl cellulose), polyvinyl pyrrolidone, methylcellulose, pre-gelatinized starch (e.g., STARCH 1500® and STARCH 1500LM®, sold by Colorcon, Ltd.), hydroxypropyl methyl cellulose,microcrystalline cellulose (e.g. AVICEL™, such as, AVICEL-PH-101™, -13™and -105™, sold by FMC Corporation, Marcus Hook, Pa., USA), or mixturesthereof,

FILLERS: talc, calcium carbonate (e.g., granules or powder), dibasiccalcium phosphate, tribasic calcium phosphate, calcium sulfate (e.g.,granules or powder), microcrystalline cellulose, powdered cellulose,dextrates, kaolin, mannitol, silicic acid, sorbitol, starch,pre-gelatinized starch, or mixtures thereof,

DISINTEGRANTS: agar-agar, alginic acid, calcium carbonate,microcrystalline cellulose, croscarmellose sodium, crospovidone,polacrilin potassium, sodium starch glycolate, potato or tapioca starch,other starches, pre-gelatinized starch, clays, other algins, othercelluloses, gums, or mixtures thereof,

LUBRICANTS: calcium stearate, magnesium stearate, mineral oil, lightmineral oil, glycerin, sorbitol, mannitol, polyethylene glycol, otherglycols, stearic acid, sodium lauryl sulfate, talc, hydrogenatedvegetable oil (e.g., peanut oil, cottonseed oil, sunflower oil, sesameoil, olive oil, corn oil and soybean oil), zinc stearate, ethyl oleate,ethyl laurate, agar, syloid silica gel (AEROSIL 200, W.R. Grace Co.,Baltimore, Md. USA), a coagulated aerosol of synthetic silica (DeaussaCo., Plano, Tex. USA), a pyrogenic silicon dioxide (CAB-O-SIL, CabotCo., Boston, Mass. USA), or mixtures thereof,

ANTI-CAKING AGENTS: calcium silicate, magnesium silicate, silicondioxide, colloidal silicon dioxide, talc, or mixtures thereof,

ANTIMICROBIAL AGENTS: benzalkonium chloride, benzethonium chloride,benzoic acid, benzyl alcohol, butyl paraben, cetylpyridinium chloride,cresol, chlorobutanol, dehydroacetic acid, ethylparaben, methylparaben,phenol, phenylethyl alcohol, phenoxyethanol, phenylmercuric acetate,phenylmercuric nitrate, potassium sorbate, propylparaben, sodiumbenzoate, sodium dehydroacetate, sodium propionate, sorbic acid,thimersol, thymo, or mixtures thereof, and

COATING AGENTS: sodium carboxymethyl cellulose, cellulose acetatephthalate, ethylcellulose, gelatin, pharmaceutical glaze, hydroxypropylcellulose, hydroxypropyl methylcellulose, hydroxypropyl methyl cellulosephthalate, methylcellulose, polyethylene glycol, polyvinyl acetatephthalate, shellac, sucrose, titanium dioxide, carnauba wax,microcrystalline wax, or mixtures thereof.

The agents either in their free form or as a salt can be combined with apolymer such as polylactic-glycoloic acid (PLGA),poly-(I)-lactic-glycolic-tartaric acid (P(I) LGT) (WO 01/12233),polyglycolic acid (U.S. Pat. No. 3,773,919), polylactic acid (U.S. Pat.No. 4,767,628), poly(β-caprolactone) and poly(alkylene oxide) (U.S.20030068384) to create a sustained release formulation. Suchformulations can be used to implants that release a peptide or anotheragent over a period of a few days, a few weeks or several monthsdepending on the polymer, the particle size of the polymer, and the sizeof the implant (see, e.g., U.S. Pat. No. 6,620,422). Other sustainedrelease formulations and polymers for use in are described in EP 0 467389 A2, WO 93/24150, U.S. Pat. No. 5,612,052, WO 97/40085, WO 03/075887,WO 01/01964A2, U.S. Pat. No. 5,922,356, WO 94/155587, WO 02/074247A2, WO98/25642, U.S. Pat. No. 5,968,895, U.S. Pat. No. 6,180,608, U.S.20030171296, U.S. 20020176841, U.S. Pat. No. 5,672,659, U.S. Pat. No.5,893,985, U.S. Pat. No. 5,134,122, U.S. Pat. No. 5,192,741, U.S. Pat.No. 5,192,741, U.S. Pat. No. 4,668,506, U.S. Pat. No. 4,713,244, U.S.Pat. No. 5,445,832 U.S. Pat. No. 4,931,279, U.S. Pat. No. 5,980,945, WO02/058672, WO 9726015, WO 97/04744, and. US20020019446. In suchsustained release formulations microparticles of peptide are combinedwith microparticles of polymer. One or more sustained release implantscan be placed in the large intestine, the small intestine or both. U.S.Pat. No. 6,011,011 and WO 94/06452 describe a sustained releaseformulation providing either polyethylene glycols (i.e. PEG 300 and PEG400) or triacetin. WO 03/053401 describes a formulation which may bothenhance bioavailability and provide controlled release of the agentwithin the GI tract. Additional controlled release formulations aredescribed in WO 02/38129, EP 326 151, U.S. Pat. No. 5,236,704, WO02/30398, WO 98/13029; U.S. 20030064105, U.S. 20030138488A1, U.S.20030216307A1, U.S. Pat. No. 6,667,060, WO 01/49249, WO 01/49311, WO01/49249, WO 01/49311, and U.S. Pat. No. 5,877,224.

The agents can be administered, e.g., by intravenous injection,intramuscular injection, subcutaneous injection, intraperitonealinjection, topical, sublingual, intraarticular (in the joints),intradermal, buccal, ophthalmic (including intraocular), intranasaly(including using a cannula), intraspinally, intrathecally, or by otherroutes. The agents can be administered orally, e.g., as a tablet orcachet containing a predetermined amount of the active ingredient, gel,pellet, paste, syrup, bolus, electuary, slurry, capsule, powder,lyophilized powder, granules, sachet, as a solution or a suspension inan aqueous liquid or a non-aqueous liquid, as an oil-in-water liquidemulsion or a water-in-oil liquid emulsion, via a micellar formulation(see, e.g. WO 97/11682) via a liposomal formulation (see, e.g., EP736299, WO 99/59550 and WO 97/13500), via formulations described in WO03/094886 or in some other form. Orally administered compositions caninclude binders, lubricants, inert diluents, lubricating, surface activeor dispersing agents, flavoring agents, and humectants. Orallyadministered formulations such as tablets may optionally be coated orscored and may be formulated so as to provide sustained, delayed orcontrolled release of the active ingredient therein. The agents can alsobe administered transdermally (i.e. via reservoir-type or matrix-typepatches, microneedles, thermal poration, hypodermic needles,iontophoresis, electroporation, ultrasound or other forms ofsonophoresis, jet injection, or a combination of any of the precedingmethods (Prausnitz et al. 2004, Nature Reviews Drug Discovery3:115-124)). The agents can be administered using high-velocitytransdermal particle injection techniques using the hydrogel particleformulation described in U.S. 20020061336. Additional particleformulations are described in WO 00/45792, WO 00/53160, and WO 02/19989.An example of a transdermal formulation containing plaster and theabsorption promoter dimethylisosorbide can be found in WO 89/04179. WO96/11705 provides formulations suitable for transdermal administration.The agents can be administered in the form a suppository or by othervaginal or rectal means. The agents can be administered in atransmembrane formulation as described in WO 90/07923. The agents can beadministed non-invasively via the dehydrated participles described inU.S. Pat. No. 6,485,706. The agent can be administered in anenteric-coated drug formulation as described in WO 02/49621. The agentscan be administered intranassaly using the formulation described in U.S.Pat. No. 5,179,079. Formulations suitable for parenteral injection aredescribed in WO 00/62759. The agents can be administered using thecasein formulation described in U.S. 20030206939 and WO 00/06108. Theagents can be administered using the particulate formulations describedin U.S. 20020034536.

The agents, alone or in combination with other suitable components, canbe administered by pulmonary route utilizing several techniquesincluding but not limited to intratracheal instillation (delivery ofsolution into the lungs by syringe), intratracheal delivery ofliposomes, insufflation (administration of powder formulation by syringeor any other similar device into the lungs) and aerosol inhalation.Aerosols (e.g., jet or ultrasonic nebulizers, metered-dose inhalers(MDIs), and dry-powder inhalers (DPIs)) can also be used in intranasalapplications. Aerosol formulations are stable dispersions or suspensionsof solid material and liquid droplets in a gaseous medium and can beplaced into pressurized acceptable propellants, such ashydrofluoroalkanes (HFAs, i.e. HFA-134a and HFA-227, or a mixturethereof), dichlorodifluoromethane (or other chlorofluocarbon propellantssuch as a mixture of Propellants 11, 12, and/or 114), propane, nitrogen,and the like. Pulmonary formulations may include permeation enhancerssuch as fatty acids, and saccharides, chelating agents, enzymeinhibitors (e.g., protease inhibitors), adjuvants (e.g., glycocholate,surfactin, span 85, and nafamostat), preservatives (e.g., benzalkoniumchloride or chlorobutanol), and ethanol (normally up to 5% but possiblyup to 20%, by weight). Ethanol is commonly included in aerosolcompositions as it can improve the function of the metering valve and insome cases also improve the stability of the dispersion. Pulmonaryformulations may also include surfactants which include but are notlimited to bile salts and those described in U.S. Pat. No. 6,524,557 andreferences therein. The surfactants described in U.S. Pat. No.6,524,557, e.g., a C₈-C₁₆ fatty acid salt, a bile salt, a phospholipid,or alkyl saccaride are advantageous in that some of them also reportedlyenhance absorption of the peptide in the formulation. Also suitable inthe invention are dry powder formulations comprising a therapeuticallyeffective amount of active compound blended with an appropriate carrierand adapted for use in connection with a dry-powder inhaler. Absorptionenhancers which can be added to dry powder formulations of the presentinvention include those described in U.S. Pat. No. 6,632,456. WO02/080884 describes new methods for the surface modification of powders.Aerosol formulations may include U.S. Pat. No. 5,230,884, U.S. Pat. No.5,292,499, WO 017/8694, WO 01/78696, U.S. 2003019437, U.S. 20030165436,and WO 96/40089 (which includes vegetable oil). Sustained releaseformulations suitable for inhalation are described in U.S.20010036481A1, 20030232019A1, and U.S. 20040018243A1 as well as in WO01/13891, WO 02/067902, WO 03/072080, and WO 03/079885. Pulmonaryformulations containing microparticles are described in WO 03/015750,U.S. 20030008013, and WO 00/00176. Pulmonary formulations containingstable glassy state powder are described in U.S. 20020141945 and U.S.Pat. No. 6,309,671. Other aerosol formulations are described in EP1338272A1 WO 90/09781, U.S. Pat. No. 5,348,730, U.S. Pat. No. 6,436,367,WO 91/04011, and U.S. Pat. No. 6,294,153 and U.S. Pat. No. 6,290,987describes a liposomal based formulation that can be administered viaaerosol or other means. Powder formulations for inhalation are describedin U.S. 20030053960 and WO 01/60341. The agents can be administeredintranasally as described in U.S. 20010038824.

Solutions of medicament in buffered saline and similar vehicles arecommonly employed to generate an aerosol in a nebulizer. Simplenebulizers operate on Bernoulli's principle and employ a stream of airor oxygen to generate the spray particles. More complex nebulizersemploy ultrasound to create the spray particles. Both types are wellknown in the art and are described in standard textbooks of pharmacysuch as Sprowls' American Pharmacy and Remington's The Science andPractice of Pharmacy. Other devices for generating aerosols employcompressed gases, usually hydrofluorocarbons and chlorofluorocarbons,which are mixed with the medicament and any necessary excipients in apressurized container, these devices are likewise described in standardtextbooks such as Sprowls and Remington.

The agents can be a free acid or base, or a pharmacologically acceptablesalt thereof. Solids can be dissolved or dispersed immediately prior toadministration or earlier. In some circumstances the preparationsinclude a preservative to prevent the growth of microorganisms. Thepharmaceutical forms suitable for injection can include sterile aqueousor organic solutions or dispersions which include, e.g., water, analcohol, an organic solvent, an oil or other solvent or dispersant(e.g., glycerol, propylene glycol, polyethylene glycol, and vegetableoils). The formulations may contain antioxidants, buffers,bacteriostats, and solutes that render the formulation isotonic with theblood of the intended recipient, and aqueous and non-aqueous sterilesuspensions that can include suspending agents, solubilizers, thickeningagents, stabilizers, and preservatives. Pharmaceutical agents can besterilized by filter sterilization or by other suitable means. The agentcan be fused to immunoglobulins or albumin, or incorporated into aliposome to improve half-life. The agent can also be conjugated topolyethylene glycol (PEG) chains. Methods for pegylation and additionalformulations containing PEG-conjugates (i.e. PEG-based hydrogels, PEGmodified liposomes) can be found in Harris and Chess, Nature ReviewsDrug Discovery 2: 214-221 and the references therein. Peptides can alsobe modified with alkyl groups (e.g., C₁-C₂₀ straight or branched alkylgroups); fatty acid radicals; and combinations of PEG, alkyl groups andfatty acid radicals (see U.S. Pat. No. 6,309,633; Soltero et al., 2001Innovations in Pharmaceutical Technology 106-110). The agent can beadministered via a nanocochleate or cochleate delivery vehicle(BioDelivery Sciences International). The agents can be deliveredtransmucosally (i.e. across a mucosal surface such as the vagina, eye ornose) using formulations such as that described in U.S. Pat. No.5,204,108. The agents can be formulated in microcapsules as described inWO 88/01165. The agent can be administered intra-orally using theformulations described in U.S. 20020055496, WO 00/47203, and U.S. Pat.No. 6,495,120. The agent can be delivered using nanoemulsionformulations described in WO 01/91728A2.

Suitable pharmaceutical compositions in accordance with the inventionwill generally include an amount of the active compound(s) with anacceptable pharmaceutical diluent or excipient, such as a sterileaqueous solution, to give a range of final concentrations, depending onthe intended use. The techniques of preparation are generally well knownin the art, as exemplified by Remington's Pharmaceutical Sciences (18thEdition, Mack Publishing Company, 1995).

The agents described herein and combination therapy agents can bepackaged as a kit that includes single or multiple doses of two or moreagents, each packaged or formulated individually, or single or multipledoses of two or more agents packaged or formulated in combination. Thus,one or more agents can be present in first container, and the kit canoptionally include one or more agents in a second container. Thecontainer or containers are placed within a package, and the package canoptionally include administration or dosage instructions. A kit caninclude additional components such as syringes or other means foradministering the agents as well as diluents or other means forformulation.

Methods to increase chemical and/or physical stability of the agents thedescribed herein are found in U.S. Pat. No. 6,541,606, U.S. Pat. No.6,068,850, U.S. Pat. No. 6,124,261, U.S. Pat. No. 5,904,935, and WO00/15224, U.S. 20030069182 (via the addition of nicotinamide), U.S.20030175230A1, U.S. 20030175230A1, U.S. 20030175239A1, U.S. 20020045582,U.S. 20010031726, WO 02/26248, WO 03/014304, WO 98/00152A1, WO98/00157A1, WO 90/12029, WO 00/04880, and WO 91/04743, WO 97/04796 andthe references cited therein.

Methods to increase bioavailability of the agents described herein arefound in U.S. Pat. No. 6,008,187, U.S. Pat. No. 5,424,289, U.S.20030198619, WO 90/01329, WO 01/49268, WO 00/32172, and WO 02/064166.Glycyrrhizinate can also be used as an absorption enhancer (see, e.g.,EP397447). WO 03/004062 discusses Ulex europaeus I (UEA1) and UEAImimetics which may be used to target the agents of the invention to theGI tract.

The agents described herein can be fused to a modified version of theblood serum protein transferrin. U.S. 20030221201, U.S. 20040023334,U.S. 20030226155, WO 04/020454, and WO 04/019872 discuss the manufactureand use of transferrin fusion proteins. Transferrin fusion proteins mayimprove circulatory half life and efficacy, decrease undesirable sideeffects and allow reduced dosage.

The peptides and agonists of the invention can be recombinantlyexpressed in bacteria. Bacteria expressing the peptide or agonists canbe administered orally, rectally, mucosally or in via some other mode ofadministration including but not limited to those described herein.

Analgesic Agents in Combitherapy

The peptides and agonists described herein can be used in combinationtherapy with an analgesic agent, e.g., an analgesic compound or ananalgesic peptide. These peptides and compounds can be administered withthe peptides of the invention (simultaneously or sequentially). They canalso be optionally covalently linked or attached to an agent describedherein to create therapeutic conjugates. Among the useful analgesicagents are: Ca channel blockers, 5HT receptor antagonists (for example5HT3, 5HT4 and 5HT1 receptor antagonists), opioid receptor agonists(loperamide, fedotozine, and fentanyl), NK1 receptor antagonists, CCKreceptor agonists (e.g., loxiglumide), NK1 receptor antagonists, NK3receptor antagonists, norepinephrine-serotonin reuptake inhibitors(NSR1), vanilloid and cannabanoid receptor agonists, and sialorphin.Analgesics agents in the various classes are described in theliterature.

Among the useful analgesic peptides are sialorphin-related peptides,including those comprising the amino acid sequence QHNPR (SEQ ID NO:),including: VQHNPR (SEQ ID NO:); VRQHNPR (SEQ ID NO:); VRGQHNPR (SEQ IDNO:); VRGPQHNPR (SEQ ID NO:); VRGPRQHNPR (SEQ ID NO:); VRGPRRQHNPR (SEQID NO:); and RQHNPR (SEQ ID NO:). Sialorphin-related peptides bind toneprilysin and inhibit neprilysin-mediated breakdown of substance P andMet-enkephalin. Thus, compounds or peptides that are inhibitors ofneprilysin are useful analgesic agents which can be administered withthe peptides of the invention in a co-therapy or linked to the peptidesof the invention, e.g., by a covalent bond. Sialophin and relatedpeptides are described in U.S. Pat. No. 6,589,750; U.S. 20030078200 A1;and WO 02/051435 A2.

Opioid receptor antagonists and agonists can be administered with thepeptides of the invention in co-therapy or linked to the agent of theinvention, e.g., by a covalent bond. For example, opioid receptorantagonists such as naloxone, naltrexone, methyl nalozone, nalmefene,cypridime, beta funaltrexamine, naloxonazine, naltrindole, andnorbinaltorphimine are thought to be useful in the treatment of IBS. Itcan be useful to formulate opioid antagonists of this type is a delayedand sustained release formulation such that initial release of theantagonist is in the mid to distal small intestine and/or ascendingcolon. Such antagonists are described in WO 01/32180 A2. Enkephalinpentapeptide (HOE825; Tyr-D-Lys-Gly-Phe-L-homoserine) is an agonist ofthe mu and delta opioid receptors and is thought to be useful forincreasing intestinal motility (Eur. J. Pharm. 219:445, 1992), and thispeptide can be used in conjunction with the peptides of the invention.Also useful is trimebutine which is thought to bind to mu/delta/kappaopioid receptors and activate release of motilin and modulate therelease of gastrin, vasoactive intestinal peptide, gastrin andglucagons. Kappa opioid receptor agonists such as fedotozine,asimadoline, and ketocyclazocine, and compounds described in WO03/097051 A2 can be used with or linked to the peptides of theinvention. In addition, mu opioid receptor agonists such as morphine,diphenyloxylate, frakefamide (H-Tyr-D-Ala-Phe(F)-Phe-NH₂; WO 01/019849A1) and loperamide can be used.

Tyr-Arg (kyotorphin) is a dipeptide that acts by stimulating the releaseof met-enkephalins to elicit an analgesic effect (J. Biol. Chem.262:8165, 1987). Kyotorphin can be used with or linked to the peptidesof the invention.

Chromogranin-derived peptide (CgA 47-66; see, e.g., Ghia et al. 2004Regulatory Peptides 119:199) can be used with or linked to the peptidesof the invention.

CCK receptor agonists such as caerulein from amphibians and otherspecies are useful analgesic agents that can be used with or linked tothe peptides of the invention.

Conotoxin peptides represent a large class of analgesic peptides thatact at voltage gated Ca channels, NMDA receptors or nicotinic receptors.These peptides can be used with or linked to the peptides of theinvention.

Peptide analogs of thymulin (FR Application 2830451) can have analgesicactivity and can be used with or linked to the peptides of theinvention.

CCK (CCKa or CCKb) receptor antagonists, including loxiglumide anddexloxiglumide (the R-isomer of loxiglumide) (WO 88/05774) can haveanalgesic activity and can be used with or linked to the peptides of theinvention.

Other useful analgesic agents include 5-HT4 agonists such as tegaserod(Zelnorm®), mosapride, metoclopramide, zacopride, cisapride, renzapride,benzimidazolone derivatives such as BIMU 1 and BIMU 8, and lirexapride.Such agonists are described in: EP1321142 A1, WO 03/053432A1, EP 505322A1, EP 505322 B1, U.S. Pat. No. 5,510,353, EP 507672 A1, EP 507672 B1,and U.S. Pat. No. 5,273,983.

Calcium channel blockers such as ziconotide and related compoundsdescribed in, for example, EP625162B1, U.S. Pat. No. 5,364,842, U.S.Pat. No. 5,587,454, U.S. Pat. No. 5,824,645, U.S. Pat. No. 5,859,186,U.S. Pat. No. 5,994,305, U.S. Pat. No. 6,087,091, U.S. Pat. No.6,136,786, WO 93/13128 A1, EP 1336409 A1, EP 835126 A1, EP 835126 B1,U.S. Pat. No. 5,795,864, U.S. Pat. No. 5,891,849, U.S. Pat. No.6,054,429, WO 97/01351 A1, can be used with or linked to the peptides ofthe invention.

Various antagonists of the NK-1, NK-2, and NK-3 receptors (for a reviewsee Giardina et al. 2003 Drugs 6:758) can be can be used with or linkedto the peptides of the invention.

NK1 receptor antagonists such as: aprepitant (Merck & Co Inc),vofopitant, ezlopitant (Pfizer, Inc.), R-673 (Hoffmann-La Roche Ltd),SR-48968 (Sanofi Synthelabo), CP-122,721 (Pfizer, Inc.), GW679769 (GlaxoSmith Kline), TAK-637 (Takeda/Abbot), SR-14033, and related compoundsdescribed in, for example, EP 873753 A1, US 20010006972 A1, US20030109417 A1, WO 01/52844 A1, can be used with or linked to thepeptides of the invention.

NK-2 receptor antagonists such as nepadutant (Menarini Ricerche SpA),saredutant (Sanofi-Synthelabo), GW597599 (Glaxo Smith Kline), SR-144190(Sanofi-Synthelabo) and UK-290795 (Pfizer Inc) can be used with orlinked to the peptides of the invention.

NK3 receptor antagonists such as osanetant (SR-142801;Sanofi-Synthelabo), SSR-241586, talnetant and related compoundsdescribed in, for example, WO 02/094187 A2, EP 876347 A1, WO 97/21680A1, U.S. Pat. No. 6,277,862, WO 98/11090, WO 95/28418, WO 97/19927, andBoden et al. (J Med Chem. 39:1664-75, 1996) can be used with or linkedto the peptides of the invention.

Norepinephrine-serotonin reuptake inhibitors (NSR1) such as milnacipranand related compounds described in WO 03/077897 A1 can be used with orlinked to the peptides of the invention.

Vanilloid receptor antagonists such as arvanil and related compoundsdescribed in WO 01/64212 A1 can be used with or linked to the peptidesof the invention.

The analgesic peptides and compounds can be administered with thepeptides and agonists of the invention (simultaneously or sequentially).The analgesic agents can also be covalently linked to the peptides andagonists of the invention to create therapeutic conjugates. Where theanalgesic is a peptide and is covalently linked to an agent describedherein the resulting peptide may also include at least one trypsincleavage site. When present within the peptide, the analgesic peptidemay be preceded by (if it is at the carboxy terminus) or followed by (ifit is at the amino terminus) a trypsin cleavage site that allows releaseof the analgesic peptide.

In addition to sialorphin-related peptides, analgesic peptides include:AspPhe, endomorphin-1, endomorphin-2, nocistatin, dalargin, lupron,ziconotide, and substance P.

Other Agents for Use in Combitherapy

Also within the invention are pharmaceutical compositions comprising apeptide or agonists of the invention and a second therapeutic agent. Thesecond therapeutic agent can be administered to treat any condition forwhich it is useful, including conditions that are not considered to bethe primary indication for treatment with the second therapeutic agent.The second therapeutic agent can be administered simultaneously orsequentially. The second therapeutic agent can be covalently linked tothe peptides and agonists of the invention to create a therapeuticconjugate. When the second therapeutic agent is another peptide, alinker including those described herein may be used between the peptideof the invention and the second therapeutic peptide.

Examples of additional therapeutic agents to treat gastrointestinal andother disorders include:

-   (1) agents to treat constipation (e.g., a chloride channel activator    such as the bicylic fatty acid, Lubiprostone (formerly known as    SPI-0211; Sucampo Pharmaceuticals, Inc.; Bethesda, Md.), a laxative    such as MiraLax; Braintree Laboratories, Braintree Mass.);-   (2) acid reducing agents such as proton pump inhibitors (e.g.,    omeprazole (Prilosec®), esomeprazole (Nexium®), lansoprazole    (Prevacid®), pantoprazole (Protonix®) and rabeprazole (Aciphex®))    and H1 stamine H2-receptor antagonist (also known as H2 receptor    blockers including cimetidine, ranitidine, famotidine and    nizatidine);-   (3) prokinetic agents including metoclopramide (Reglan®),    domperidone (Motilium®), erythromycin or cisapride (Propulsid®)-   (4) pro-motility agents such as the vasostatin-derived peptide,    chromogranin A (4-16) (see, e.g., Ghia et al. 2004 Regulatory    Peptides 121:31) or motilin agonists (e.g., GM-611 or mitemcinal    fumarate);-   (5) complete or partial 5HT (e.g. 5HT1, 5HT2, 5HT3, 5HT4) receptor    agonists or antagonists (including 5HT4 receptor agonists (such as    tegaserod (ZELNORM®), mosapride, metoclopramide, zacopride,    cisapride, renzapride, benzimidazolone derivatives such as BIMU 1    and BIMU 8, and lirexapride. Such agonists are described in:    EP1321142 A1, WO 03/053432A1, EP 505322 A1, EP 505322 B1, U.S. Pat.    No. 5,510,353, EP 507672 A1, EP 507672 B1, and U.S. Pat. No.    5,273,983); 5HT3 receptor agonists such as MKC-733; and 5HT3    receptor antagonists such as alosetron and ATI-7000 (Aryx    Therapeutics, Santa Clara Calif.);-   (6) muscarinic receptor agonists;-   (7) anti-inflammatory agents;-   (8) antispasmodics;-   (9) antidepressants;-   (10) centrally-acting analgesic agents such as opioid receptor    agonists, opioid receptor antagonists (e.g., naltrexone);-   (11) agents for the treatment of Inflammatory bowel disease;-   (12) agents for the treatment of Crohn's disease and/or ulcerative    colitis (e.g., alequel (Enzo Biochem, Inc.; Farmingsale, N.Y.), the    anti-inflammatory peptide RDP58 (Genzyme, Inc.; Cambridge, Mass.),    and TRAFICET-EN™ (ChemoCentryx, Inc.; San Carlos, Calif.);-   (13) agents that treat gastrointestinal or visceral pain;-   (14) PDE (phosphodiesterase) inhibitors including but not limited to    those disclosed herein;-   (15) purgatives that draw fluids to the intestine (e.g., VISICOL®, a    combination of sodium phosphate monobasic monohydrate and sodium    phosphate dibasic anhydrate);-   (16) Corticotropin Releasing Factor (CRF) receptor antagonists    (including NBI-34041 (Neurocrine Biosciences, San Diego, Calif.),    CRH9-41, astressin, R121919 (Janssen Pharmaceutica), CP154,526,    NBI-27914, Antalarmin, DMP696 (Bristol-Myers Squibb) CP-316,311    (Pfizer, Inc.), GW876008 (Neurocrine/Glaxo Smith Kline), ONO-2333Ms    (Ono Pharmaceuticals), TS-041 (Janssen), AAG561 (Novartis) and those    disclosed in U.S. Pat. No. 5,063,245, U.S. Pat. No. 5,861,398,    US20040224964, US20040198726, US20040176400, US20040171607,    US20040110815, and US20040006066);-   (17) glucagon-like peptides (glp-1) and analogues thereof (including    exendin-4) and inhibitors of DPP-IV (DPP-IV mediates the    inactivation of glp-1);-   (18) tofisopam, enantiomerically-pure R-tofisopam, and    pharmaceutically-acceptable salts thereof (US 20040229867)-   (19) the tricyclic anti-depressant of the dibenzothiazepine type,    tianeptine (Stablon®) and other agents described in U.S. Pat. No.    6,683,072;-   (20) (E)-4    (1,3bis(cyclohexylmethyl)-1,2,34,-tetrahydro-2,6-diono-9H-purin-8-yl)cinnamic    acid nonaethylene glycol methyl ether ester and related compounds    described in WO 02/067942; and-   (21) the probiotic PROBACTRIX® (The BioBalance Corporation; New    York, N.Y.) which contains microorganisms useful in the treatment of    gastrointestinal disorders.

The peptides and agonists of the invention can be used in combinationtherapy with insulin and related compounds including primate, rodent, orrabbit insulin including biologically active variants thereof includingallelic variants, more preferably human insulin available in recombinantform. Sources of human insulin include pharmaceutically acceptable andsterile formulations such as those available from Eli Lilly(Indianapolis, Ind. 46285) as Humulin™ (human insulin rDNA origin). Seethe THE PHYSICIAN'S DESK REFERENCE, 55.sup.th Ed. (2001) MedicalEconomics, Thomson Healthcare (disclosing other suitable humaninsulins). The peptides of the invention can also be used in combinationtherapy with agents that can boost insulin effects or levels of asubject upon administration, e.g. glipizide and/or rosiglitazone. Thepeptides and agonists of the invention can be used in combitherapy withSYMLIN® (pramlintide acetate) and Exenatide® (synthetic exendin-4; a 39aa peptide).

The peptides and agonists of the invention can also be used incombination therapy with agents (e.g., Entereg™ (alvimopan; formerlycalled adolor/ADL 8-2698), conivaptan and related agents describe inU.S. Pat. No. 6,645,959) for the treatment of postoperative ileus.

The peptides and agonists of the invention can be used in combinationtherapy with an anti-hypertensive agent including but not limited to:

-   (1) diuretics, such as thiazides, including chlorthalidone,    chlorthiazide, dichlorophenamide, hydroflumethiazide, indapamide,    polythiazide, and hydrochlorothiazide; loop diuretics, such as    bumetanide, ethacrynic acid, furosemide, and torsemide; potassium    sparing agents, such as amiloride, and triamterene; and aldosterone    antagonists, such as spironolactone, epirenone, and the like;-   (2) beta-adrenergic blockers such as acebutolol, atenolol,    betaxolol, bevantolol, bisoprolol, bopindolol, carteolol,    carvedilol, celiprolol, esmolol, indenolol, metaprolol, nadolol,    nebivolol, penbutolol, pindolol, propanolol, sotalol, tertatolol,    tilisolol, and timolol, and the like;-   (3) calcium channel blockers such as amlodipine, aranidipine,    azelnidipine, bamidipine, benidipine, bepridil, cinaldipine,    clevidipine, diltiazem, efonidipine, felodipine, gallopamil,    isradipine, lacidipine, lemildipine, lercanidipine, nicardipine,    nifedipine, nilvadipine, nimodepine, nisoldipine, nitrendipine,    manidipine, pranidipine, and verapamil, and the like;-   (4) angiotensin converting enzyme (ACE) inhibitors such as    benazepril; captopril; ceranapril; cilazapril; delapril; enalapril;    enalopril; fosinopril; imidapril; lisinopril; losinopril; moexipril;    quinapril; quinaprilat; ramipril; perindopril; perindropril;    quanipril; spirapril; tenocapril; trandolapril, and zofenopril, and    the like;-   (5) neutral endopeptidase inhibitors such as omapatrilat, cadoxatril    and ecadotril, fosidotril, sampatrilat, AVE7688, ER4030, and the    like;-   (6) endothelin antagonists such as tezosentan, A308165, and YM62899,    and the like;-   (7) vasodilators such as hydralazine, clonidine, minoxidil, and    nicotinyl alcohol, and the like;-   (8) angiotensin II receptor antagonists such as aprosartan,    candesartan, eprosartan, irbesartan, losartan, olmesartan,    pratosartan, tasosartan, telmisartan, valsartan, and EXP-3137,    F16828K, and RNH6270, and the like;-   (9) a/p adrenergic blockers such as nipradilol, arotinolol and    amosulalol, and the like;-   (10) alpha 1 blockers, such as terazosin, urapidil, prazosin,    tamsulosin, bunazosin, trimazosin, doxazosin, naftopidil, indoramin,    WHP 164, and XEN010, and the like;-   (11) alpha 2 agonists such as lofexidine, tiamenidine, moxonidine,    rilmenidine and guanobenz, and the like;-   (12) aldosterone inhibitors, and the like; and-   (13) angiopoietin-2-binding agents such as those disclosed in    WO03/030833.

The peptides and agonists of the invention can be used in combinationtherapy with one or more of the following agents useful in the treatmentof respiratory and other disorders:

-   (1) β-agonists including but not limited to: albuterol (PROVENTIL®,    SALBUTAMOl®, VENTOLIN®), bambuterol, bitoterol, clenbuterol,    fenoterol, formoterol, isoetharine (BRONKOSOL®, BRONKOMETER®),    metaproterenol (ALUPENT®, METAPREL®), pirbuterol (MAXAIR®),    reproterol, rimiterol, salmeterol, terbutaline (BRETHAIRE®,    BRETHINE®, BRICANYL®), adrenalin, isoproterenol (ISUPREL®),    epinephrine bitartrate (PRIMATENE®), ephedrine, orciprenline,    fenoterol and isoetharine;-   (2) steroids, including but not limited to beclomethasone,    beclomethasone dipropionate, betamethasone, budesonide, bunedoside,    butixocort, dexamethasone, flunisolide, fluocortin, fluticasone,    hydrocortisone, methyl prednisone, mometasone, predonisolone,    predonisone, tipredane, tixocortal, triamcinolone, and triamcinolone    acetonide;-   (3) β2-agonist-corticosteroid combinations [e.g.,    salmeterol-fluticasone (ADVAIR®), formoterol-budesonid    (SYMBICORT®)];-   (4) leukotriene D4 receptor antagonists/leukotriene antagonists/LTD4    antagonists (i.e., any compound that is capable of blocking,    inhibiting, reducing or otherwise interrupting the interaction    between leukotrienes and the Cys LTI receptor) including but not    limited to: zafirlukast, montelukast, montelukast sodium    (SINGULAIR®), pranlukast, iralukast, pobilukast, SKB-106,203 and    compounds described as having LTD4 antagonizing activity described    in U.S. Pat. No. 5,565,473;-   (5) 5-lipoxygenase inhibitors and/or leukotriene biosynthesis    inhibitors [e.g., zileuton and BAY1005 (CA registry 128253-31-6)];-   (6) histamine H1 receptor antagonists/antihistamines (i.e., any    compound that is capable of blocking, inhibiting, reducing or    otherwise interrupting the interaction between histamine and its    receptor) including but not limited to: astemizole, acrivastine,    antazoline, azatadine, azelastine, astamizole, bromopheniramine,    bromopheniramine maleate, carbinoxamine, carebastine, cetirizine,    chlorpheniramine, chloropheniramine maleate, cimetidine, clemastine,    cyclizine, cyproheptadine, descarboethoxyloratadine,    dexchlorpheniramine, dimethindene, diphenhydramine,    diphenylpyraline, doxylamine succinate, doxylamine, ebastine,    efletirizine, epinastine, farnotidine, fexofenadine, hydroxyzine,    hydroxyzine, ketotifen, levocabastine, levocetirizine,    levocetirizine, loratadine, meclizine, mepyramine, mequitazine,    methdilazine, mianserin, mizolastine, noberastine, norasternizole,    noraztemizole, phenindamine, pheniramine, picumast, promethazine,    pynlamine, pyrilamine, ranitidine, temelastine, terfenadine,    trimeprazine, tripelenamine, and triprolidine;-   (7) an anticholinergic including but not limited to: atropine,    benztropine, biperiden, flutropium, hyoscyamine, ilutropium,    ipratropium, ipratropium bromide, methscopolamine, oxybutinin,    rispenzepine, scopolamine, and tiotropium;-   (8) an anti-tussive including but not limited to: dextromethorphan,    codeine, and hydromorphone;-   (9) a decongestant including but not limited to: pseudoephedrine and    phenylpropanolamine;-   (10) an expectorant including but not limited to: guafenesin,    guaicolsulfate, terpin, ammonium chloride, glycerol guaicolate, and    iodinated glycerol;-   (11) a bronchodilator including but not limited to: theophylline and    aminophylline;-   (12) an anti-inflammatory including but not limited to:    fluribiprofen, diclophenac, indomethacin, ketoprofen,    S-ketroprophen, tenoxicam;-   (13) a PDE (phosphodiesterase) inhibitor including but not limited    to those disclosed herein;-   (14) a recombinant humanized monoclonal antibody [e.g. xolair (also    called omalizumab), rhuMab, and talizumab];-   (15) a humanized lung surfactant including recombinant forms of    surfactant proteins SP-B, SP-C or SP-D [e.g. SURFAXIN®, formerly    known as dsc-104 (Discovery Laboratories)],-   (16) agents that inhibit epithelial sodium channels (ENaC) such as    amiloride and related compounds;-   (17) antimicrobial agents used to treat pulmonary infections such as    acyclovir, amikacin, amoxicillin, doxycycline, trimethoprin    sulfamethoxazole, amphotericin B, azithromycin, clarithromycin,    roxithromycin, clarithromycin, cephalosporins (ceffoxitin,    cefmetazole etc), ciprofloxacin, ethambutol, gentimycin,    ganciclovir, imipenem, isoniazid, itraconazole, penicillin,    ribavirin, rifampin, rifabutin, amantadine, rimantidine,    streptomycin, tobramycin, and vancomycin;-   (18) agents that activate chloride secretion through Ca++ dependent    chloride channels (such as purinergic receptor (P2Y(2) agonists);-   (19) agents that decrease sputum viscosity, such as human    recombinant DNase 1, (Pulmozyme®);-   (20) nonsteroidal anti-inflammatory agents (acemetacin,    acetaminophen, acetyl salicylic acid, aldlofenac, alminoprofen,    apazone, aspirin, benoxaprofen, bezpiperylon, bucloxic acid,    carprofen, clidanac, diclofenac, diclofenac, diflunisal, diflusinal,    etodolac, fenbufen, fenbufen, fenclofenac, fenclozic acid,    fenoprofen, fentiazac, feprazone, flufenamic acid, flufenisal,    flufenisal, fluprofen, flurbiprofen, flurbiprofen, furofenac,    ibufenac, ibuprofen, indomethacin, indomethacin, indoprofen,    isoxepac, isoxicam, ketoprofen, ketoprofen, ketorolac, meclofenamic    acid, meclofenamic acid, mefenamic acid, mefenamic acid, miroprofen,    mofebutazone, nabumetone oxaprozin, naproxen, naproxen, niflumic    acid, oxaprozin, oxpinac, oxyphenbutazone, phenacetin,    phenylbutazone, phenylbutazone, piroxicam, piroxicam, pirprofen,    pranoprofen, sudoxicam, tenoxican, sulfasalazine, sulindac,    sulindac, suprofen, tiaprofenic acid, tiopinac, tioxaprofen,    tolfenamic acid, tolmetin, tolmetin, zidometacin, zomepirac, and    zomepirac); and-   (21) aerosolized antioxidant therapeutics such as    S-Nitrosoglutathione.

The peptides and agonists of the invention can be used in combinationtherapy with an anti-obesity agent including but not limited to:

-   (1) 11β HSD-1 (11-beta hydroxy steroid dehydrogenase type 1)    inhibitors, such as BVT 3498, BVT 2733,    3-(1-adamantyl)-4-ethyl-5-(ethylthio)-4H-1,2,4-triazole,    3-(1-adamantyl)-5-(3,4,5-trimethoxyphenyl)-4-methyl-4H-1,2,4-triazole,    3-adamantanyl-4,5,6,7,8,9,10,11,12,3a-decahydro-1,2,4-triazolo[4,3-a][11]annulene,    and those compounds disclosed in WO01/90091, WO01/90090, WO01/90092    and WO02/072084;-   (2) 5HT (serotonin) transporter inhibitors, such as paroxetine,    fluoxetine (Prozac®), fenfluramine, fluvoxamine, sertraline, and    imipramine, and those disclosed in WO03/00663;-   (3) 5HT antagonists such as those in WO03/037871, WO03/037887, and    the like;-   (4) 5HT1a modulators such as those disclosed in WO03/031439, and the    like;-   (5) 5HT-2 agonists;-   (6) 5HT2c (serotonin receptor 2c) agonists, such as BVT933,    DPCA37215, IK264, PNU 22394, WAY161503, R-1065, SB 243213 (Glaxo    Smith Kline) and YM 348 and those disclosed in U.S. Pat. No.    3,914,250 and PCT publication Nos. WO02/36596, WO02/48124,    WO02/10169, WO01/66548, WO02/44152, WO02/51844, WO02/40456, and    WO02/40457;-   (7) 5HT6 receptor modulators, such as those in WO03/030901,    WO03/035061, WO03/039547, and the like;-   (8) ACC2 (acetyl-CoA carboxylase-2) inhibitors;-   (9) acyl-estrogens, such as oleoyl-estrone, disclosed in del    Mar-Grasa, M. et al., Obesity Research, 9:202-9 (2001) and Japanese    Patent Application No. JP 2000256190;-   (10) alpha-lipoic acid (alpha-LA);-   (11) anorectic bicyclic compounds such as 1426 (Aventis) and 1954    (Aventis), and the compounds disclosed in WO00/18749, WO01/32638,    WO01/62746, WO01/62747, and WO03/015769;-   (12) AOD9604;-   (13) appetite suppressants such as those in WO03/40107;-   (14) ATL-962 (Alizyme PLC);-   (15) benzocaine;-   (16) benzphetamine hydrochloride (Didrex);-   (17) bladderwrack (focus vesiculosus);-   (18) BRS3 (bombesin receptor subtype 3) agonists;-   (19) bupropion;-   (20) caffeine;-   (21) CB 1 (cannabinoid-1 receptor) antagonist/inverse agonists, such    as rimonabant (Acomplia; Sanofi Synthelabo), SR-147778 (Sanofi    Synthelabo), BAY 65-2520 (Bayer), and SLV 319 (Solvay), and those    disclosed in U.S. Pat. Nos. 4,973,587, 5,013,837, 5,081,122,    5,112,820, 5,292,736, 5,532,237, 5,624,941, 6,028,084, and 6,509,367    and WO96/33159, WO97/29079, WO98/31227, WO98/33765, WO98/37061,    WO98/41519, WO98/43635, WO98/43636, WO99/02499, WO00/10967,    WO00/10968, WO01/09120, WO01/58869, WO01/64632, WO01/64633,    WO01/64634, WO01/70700, WO01/96330, WO02/076949, WO03/006007,    WO03/007887, WO03/020217, WO03/026647, WO03/026648, WO03/027069,    WO03/027076, WO03/027114, WO03/037332, WO03/040107, WO03/086940,    WO03/084943 and U.S. Pat. No. 6,509,367 and EPO Application No.    EP-658546;-   (22) CCK agonists;-   (23) CCK-A (cholecystokinin-A) agonists, such as AR-R 15849, GI    181771, JMV-180, A-71378, A-71623 and SR146131, and those described    in U.S. Pat. No. 5,739,106;-   (24) chitosan;-   (25) chromium;-   (26) CNTF (Ciliary neurotrophic factors), such as GI-181771    (Glaxo-SmithKline), SR146131 (Sanofi Synthelabo), butabindide,    PD170,292, and PD 149164 (Pfizer);-   (27) CNTF derivatives, such as axokine (Regeneron), and those    disclosed in PCT Application Nos. WO 94/09134, WO 98/22128, and WO    99/43813;-   (28) conjugated linoleic acid;-   (29) corticotropin-releasing hormone agonists;-   (30) dehydroepiandrosterone;-   (31) DGAT1 (diacylglycerol acyltransferase 1) inhibitors;-   (32) DGAT2 (diacylglycerol acyltransferase 2) inhibitors;-   (33) dicarboxylate transporter inhibitors;-   (34) diethylpropion hydrochloride (Tenuate);-   (35) dipeptidyl peptidase IV (DP-IV) inhibitors, such as isoleucine    thiazolidide, valine pyrrolidide, NVP-DPP728, LAF237, P93/01, TSL    225, TMC-2A/2B/2C, FE 999011, P9310/K364, VIP 0177, SDZ 274-444 and    the compounds disclosed in PCT publication Nos. WO02/083128,    WO02/062764, WO03/000180, WO03/000181, WO03/000250, WO03/002530,    WO03/002531, WO03/002553, WO03/002593, WO03/004498, WO03/004496,    WO03/017936, WO03/024942, WO03/024965, WO03/033524, WO03/037327 and    EP1258476;-   (36) ephedra;-   (37) exendin-4 (an inhibitor of glp-1)-   (38) FAS (fatty acid synthase) inhibitors, such as Cerulenin and    C75;-   (39) fat resorption inhibitors such as those in WO03/053451, and the    like;-   (40) fatty acid transporter inhibitors;-   (41) fiber (psyllium, plantago, guar fiber);-   (42) galanin antagonists;-   (43) galega (Goat's Rue, French Lilac);-   (44) garcinia cambogia;-   (45) germander (teucrium chamaedrys);-   (46) ghrelin antagonists, such as those disclosed in PCT Application    Nos. WO 01/87335, and WO 02/08250;-   (47) GLP-1 (glucagon-like peptide 1) agonists (e.g. exendin-4);-   (48) glp-1 (glucagon-like peptide-1);-   (49) glucocorticoid antagonists;-   (50) glucose transporter inhibitors;-   (51) growth hormone secretagogue receptor agonists/antagonists, such    as NN703, hexarelin, MK-0677, SM-130686, CP-424,391, L-692,429 and    L-163,255, and such as those disclosed in U.S. Pat. No. 6,358,951,    U.S. Patent Application Nos. 2002/049196 and 2002/022637, and PCT    Application Nos. WO 01/56592 and WO 02/32888;-   (52) growth hormone secretagogues, such as those disclosed and    specifically described in U.S. Pat. No. 5,536,716;-   (53) H3 (histamine H3) antagonist/inverse agonists, such as    thioperamide, 3-(1H-imidazol-4-yl)propyl N-(4-pentenyl)carbamate),    clobenpropit, iodophenpropit, imoproxifan, GT2394 (Gliatech), and    A331440, and those disclosed in PCT publication No. WO02/15905 and    O-[3-(1H-imidazol-4-yl)propanol]carbamates (Kiec-Kononowicz, K. et    al., Pharmazie, 55:349-55 (2000)), piperidine-containing histamine    H3-receptor antagonists (Lazewska, D. et al., Pharmazie, 56:927-32    (2001), benzophenone derivatives and related compounds (Sasse, A. et    al., Arch. Pharm. (Weinheim) 334:45-52 (2001)), substituted    N-phenylcarbamates (Reidemeister, S. et al., Pharmazie, 55:83-6    (2000)), and proxifan derivatives (Sasse, A. et al., J. Med. Chem.    43:3335-43 (2000)) and histamine H3 receptor modulators such as    those disclosed in WO03/024928 and WO03/024929;-   (54) interleukin-6 (IL-6) and modulators thereof, as in WO03/057237,    and the like;-   (55) L-carnitine;-   (56) leptin derivatives, such as those disclosed in U.S. Pat. Nos.    5,552,524, 5,552,523, 5,552,522, 5,521,283, and PCT International    Publication Nos. WO 96/23513, WO 96/23514, WO 96/23515, WO 96/23516,    WO 96/23517, WO 96/23518, WO 96/23519, and WO 96/23520;-   (57) leptin, including recombinant human leptin (PEG-OB, Hoffman La    Roche) and recombinant methionyl human leptin (Amgen);-   (58) lipase inhibitors, such as tetrahydrolipstatin    (orlistat/Xenical®), Triton WR1339, RHC80267, lipstatin, teasaponin,    and diethylumbelliferyl phosphate, FL-386, WAY-121898, Bay-N-3176,    valilactone, esteracin, ebelactone A, ebelactone B, and RHC 80267,    and those disclosed in PCT publication No. WO01/77094, and U.S. Pat.    Nos. 4,598,089, 4,452,813, 5,512,565, 5,391,571, 5,602,151,    4,405,644, 4,189,438, and 4,242,453;-   (59) lpid metabolism modulators such as maslinic acid, erythrodiol,    ursolic acid uvaol, betulinic acid, betulin, and the like and    compounds disclosed in WO03/011267;-   (60) Mc3r (melanocortin 3 receptor) agonists;-   (61) Mc4r (melanocortin 4 receptor) agonists, such as CHIR86036    (Chiron), ME-10142, ME-10145, and HS-131 (Melacure), and those    disclosed in PCT publication Nos. WO99/64002, WO00/74679,    WO01/991752, WO01/25192, WO01/52880, WO01/74844, WO01/70708,    WO01/70337, WOO/91752, WO02/059095, WO02/059107, WO02/059108,    WO02/059117, WO02/06276, WO02/12166, WO02/11715, WO02/12178,    WO02/15909, WO02/38544, WO02/068387, WO02/068388, WO02/067869,    WO02/081430, WO03/06604, WO03/007949, WO03/009847, WO03/009850,    WO03/013509, and WO03/031410;-   (62) Mc5r (melanocortin 5 receptor) modulators, such as those    disclosed in WO97/19952, WO00/15826, WO00/15790, US 20030092041;-   (63) MCH2R (melanin concentrating hormone 2R) agonist/antagonists;-   (64) melanin concentrating hormone antagonists;-   (65) melanin-concentrating hormone 1 receptor (MCHR) antagonists,    such as T-226296 (Takeda), SNP-7941 (Synaptic), and those disclosed    WO01/21169, WO01/82925, WO01/87834, WO02/051809, WO02/06245,    WO02/076929, WO02/076947, WO02/04433, WO02/51809, WO02/083134,    WO02/094799, WO03/004027, WO03/13574, WO03/15769, WO03/028641,    WO03/035624, WO03/033476, WO03/033480 and Japanese Patent    Application Nos. JP 13226269, and JP1437059;-   (66) melanocortin agonists, such as Melanotan II or those described    in WO 99/64002 and WO 00/74679;-   (67) Metformin (GLUCOPHAGE®);-   (68) mGluR5 modulators such as those disclosed in WO03/029210,    WO03/047581, WO03/048137, WO03/051315, WO03/051833, WO03/053922,    WO03/059904, and the like;-   (69) monoamine reuptake inhibitors, such as sibutratmine    (Meridia®/Reductil®) and salts thereof, and those compounds    disclosed in U.S. Pat. Nos. 4,746,680, 4,806,570, and 5,436,272, and    U.S. Patent Publication No. 2002/0006964, and WO01/27068, and    WO01/62341;-   (70) NE (norepinephrine) transport inhibitors, such as GW 320659,    despiramine, talsupram, and nomifensine;-   (71) nomame herba;-   (72) non-selective serotonin/norepinephrine transport inhibitors,    such as sibutramine or fenfluramine;-   (73) NPY 1 antagonists, such as BIBP3226, J-115814, BIBO 3304,    LY-357897, CP-671906, GI-264879A, and those disclosed in U.S. Pat.    No. 6,001,836, and PCT Patent Publication Nos. WO 96/14307, WO    01/23387, WO 99/51600, WO 01/85690, WO 01/85098, WO 01/85173, and WO    01/89528;-   (74) NPY5 (neuropeptide Y Y5) antagonists, such as 152,804,    GW-569180A, GW-594884A, GW-587081X, GW-548118X, FR235208, FR226928,    FR240662, FR252384, 1229U91, GI-264879A, CGP71683A, LY-377897,    LY-366377, PD-160170, SR-120562A, SR-120819A, JCF-104, and H409/22    and those compounds disclosed in U.S. Pat. Nos. 6,140,354,    6,191,160, 6,258,837, 6,313,298, 6,326,375, 6,329,395, 6,335,345,    6,337,332, 6,329,395, and 6,340,683, European Patent Nos.    EP-01010691, and EP-01044970 and PCT Publication Nos. WO97/19682,    WO97/20820, WO97/20821, WO97/20822, WO97/20823, WO98/27063,    WO00/107409, WO00/185714, WO00/185730, WO00/64880, WO00/68197,    WO00/69849, WO01/09120, WO01/14376, WO01/85714, WO01/85730,    WO01/07409, WO01/02379, WO01/23388, WO01/23389, WO01/44201,    WO01/62737, WO01/62738, WO01/09120, WO02/20488, WO02/22592,    WO02/48152, WO02/49648, WO02/051806, WO02/094789, WO03/009845,    WO03/014083, WO03/022849, WO03/028726 and Norman et al., J. Med.    Chem. 43:4288-4312 (2000);-   (75) opioid antagonists, such as nalmefene (REVEX®),    3-methoxynaltrexone, naloxone, and naltrexone and those disclosed in    WO00/21509;-   (76) orexin antagonists, such as SB-334867-A and those disclosed in    PCT publication Nos. WO01/96302, WO01/68609, WO02/44172, WO02/51232,    WO02/51838, WO02/089800, WO02/090355, WO03/023561, WO03/032991, and    WO03/037847;-   (77) PDE (phosphodiesterase) inhibitors including but not limited to    those disclosed herein;-   (78) peptide YY and fragments and variants thereof (e.g. YY3-36    (PYY3-36) (N. Engl. J. Med. 349:941, 2003; IKPEAPGE DASPEELNRY    YASLRHYLNL VTRQRY (SEQ ID NO:XXX)) and PYY agonists such as those    disclosed in WO03/026591;-   (79) phendimetrazine;-   (80) phentermine,-   (81) phosphate transporter inhibitors;-   (82) phosphodiesterase-3B (PDE3B) inhibitors;-   (83) phytopharm compound 57 (CP 644,673);-   (84) pyruvate;-   (85) SCD-1 (stearoyl-CoA desaturase-1) inhibitors;-   (86) serotonin reuptake inhibitors, such as dexfenfluramine,    fluoxetine, and those in U.S. Pat. No. 6,365,633, and WO01/27060,    and WO01/162341;-   (87) T71 (Tularik; Inc.; Boulder Colo.);-   (88) thyroid hormone β agonists, such as KB-2611 (KaroBioBMS), and    those disclosed in WO02/15845 and Japanese Patent Application No. JP    2000256190;-   (89) Topiramate (TOPIMAX®);-   (90) transcription factor modulators such as those disclosed in    WO03/026576;-   (91) UCP-1 (uncoupling protein-1), 2, or 3 activators, such as    phytanic acid,    4-[(E)-2-(5,6,7,8-tetrahydro-5,5,8,8-tetramethyl-2-napthalenyl)-1-propeny-1]benzoic    acid (TTNPB), retinoic acid, and those disclosed in PCT Patent    Application No. WO 99/00123;-   (92) β3 (beta adrenergic receptor 3) agonists, such as AD9677/TAK677    (Dainippon/Takeda), CL-316,243, SB 418790, BRL-37344, L-796568,    BMS-196085, BRL-35135A, CGP12177A, BTA-243, GW 427353, Trecadrine,    Zeneca D7114, N-5984 (Nisshin Kyorin), LY-377604 (Lilly), and SR    59119A, and those disclosed in U.S. Pat. No. 5,705,515, U.S. Pat.    No. 5,451,677 and PCT publication Nos. WO94/18161, WO95/29159,    WO97/46556, WO98/04526 and WO98/32753, WO01/74782, WO02/32897,    WO03/014113, WO03/016276, WO03/016307, WO03/024948, WO03/024953 and    WO03/0378811;-   (93) β-hydroxy steroid dehydrogenase-1 inhibitors (β -HSD-1) and-   (94) β-hydroxy-β-methylbutyrate.

Peptides and agonists of the invention useful in the treatment ofobesity can be administered as a cotherapy with electrostimulation(US20040015201).

The peptides and agonists of the invention can be used in combinationtherapy with agents that activate soluble guanylate cyclase, for examplethose described in US20040192680.

The peptides and agonists of the invention can be used in combinationtherapy with a phosphodiesterase inhibitor. PDE inhibitors within themeaning of the present invention are those compounds which slow thedegradation of cyclic AMP (cAMP) and/or cyclic GMP (cGMP) by inhibitionof the phosphodiesterases, which can lead to a relative increase in theintracellular concentration of cAMP and cGMP. Possible PDE inhibitorswithin the meaning of the present invention are primarily thosesubstances which are to be numbered among the class consisting of thePDE3 inhibitors, the class consisting of the PDE4 inhibitors and/or theclass consisting of the PDE5 inhibitors, in particular those substanceswhich can be designated as mixed types of PDE3/4 inhibitors or as mixedtypes of PDE3/4/5 inhibitors. By way of example, those PDE inhibitorsmay be mentioned such as are described and/or claimed in the followingpatent applications and patents: DE1470341, DE2108438, DE2123328,DE2305339, DE2305575, DE2315801, DE2402908, DE2413935, DE2451417,DE2459090, DE2646469, DE2727481, DE2825048, DE2837161, DE2845220,DE2847621, DE2934747, DE3021792, DE3038166, DE3044568, EP000718,EP0008408, EP0010759, EP0059948, EP0075436, EP0096517, EP0112987,EP0116948, EP0150937, EP0158380, EP0161632, EP0161918, EP0167121,EP0199127, EP0220044, EP0247725, EP0258191, EP0272910, EP0272914,EP0294647, EP0300726, EP0335386, EP0357788, EP0389282, EP0406958,EP0426180, EP0428302, EP0435811, EP0470805, EP0482208, EP0490823,EP0506194, EP0511865, EP0527117, EP0626939, EP0664289, EP0671389,EP0685474, EP0685475, EP0685479, JP92234389, JP94329652, JP95010875,U.S. Pat. Nos. 4,963,561, 5,141,931, WO9117991, WO9200968, WO9212961,WO9307146, WO9315044, WO9315045, WO9318024, WO9319068, WO9319720,WO9319747, WO9319749, WO9319751, WO9325517, WO9402465, WO9406423,WO9412461, WO9420455, WO9422852, WO9425437, WO9427947, WO9500516,WO9501980, WO9503794, WO9504045, WO9504046, WO9505386, WO9508534,WO9509623, WO9509624, WO9509627, WO9509836, WO9514667, WO9514680,WO9514681-, WO9517392, WO9517399, WO9519362, WO9522520, WO9524381,WO9527692, WO9528926, WO9535281, WO9535282, WO9600218, WO9601825,WO9602541, WO9611917, DE3142982, DE1116676, DE2162096, EP0293063,EP0463756, EP0482208, EP0579496, EP0667345 U.S. Pat. No. 6,331,543,US20050004222 (including those disclosed in formulas I-XIII andparagraphs 37-39, 85-0545 and 557-577) and WO9307124, EP0163965,EP0393500, EP0510562, EP0553174, WO9501338 and WO9603399. PDE5inhibitors which may be mentioned by way of example are RX-RA-69,SCH-51866, KT-734, vesnarinone, zaprinast, SKF-96231, ER-21355,BF/GP-385, NM-702 and sildenafil (Viagra®). PDE4 inhibitors which may bementioned by way of example are RO-20-1724, MEM 1414 (R1533/R1500;Pharmacia Roche), DENBUFYLLINE, ROLIPRAM, OXAGRELATE, NITRAQUAZONE,Y-590, DH-6471, SKF-94120, MOTAPIZONE, LIXAZINONE, INDOLIDAN, OLPRINONE,ATIZORAM, KS-506-G, DIPAMFYLLINE, BMY-43351, ATIZORAM, AROFYLLINE,FILAMINAST, PDB-093, UCB-29646, CDP-840, SKF-107806, PICLAMILAST,RS-17597, RS-25344-000, SB-207499, TIBENELAST, SB-210667, SB-211572,SB-211600, SB-212066, SB-212179, GW-3600, CDP-840, MOPIDAMOL,ANAGRELIDE, IBUDILAST, AMRINONE, PIMOBENDAN, CILOSTAZOL, QUAZINONE andN-(3,5-dichloropyrid-4-yl)-3-cyclopropylmethoxy-4-difluoromethoxybenzamide.PDE3 inhibitors which may be mentioned by way of example are SULMAZOLE,AMPIZONE, CILOSTAMIDE, CARBAZERAN, PIROXIMONE, IMAZODAN, CI-930,SIGUAZODAN, ADIBENDAN, SATERINONE, SKF-95654, SDZ-MKS-492, 349-U-85,EMORADAN, EMD-53998, EMD-57033, NSP-306, NSP-307, REVIZINONE, NM-702,WIN-62582 and WIN-63291, ENOXIMONE and MILRINONE. PDE3/4 inhibitorswhich may be mentioned by way of example are BENAFENTRINE, TREQUINSIN,ORG-30029, ZARDAVERINE, L-686398, SDZ-ISQ-844, ORG-20241, EMD-54622, andTOLAFENTRINE. Other PDE inhibitors include: cilomilast, pentoxifylline,roflumilast, tadalafil (Clalis®), theophylline, and vardenafil(Levitra®), zaprinast (PDE5 specific).

Methods of Treatment

A number of disorders might be treated with GC-C receptor agonists andagents that increase cGMP levels including the peptides and agonists ofthe invention.

The peptides and agonists of the invention can be used alone or incombination therapy for the treatment or prevention of congestive heartfailure. Such agents can be used in combination with natriureticpeptides (e.g., atrial natriuretic peptide, brain natriuretic peptide orC-type natriuretic peptide), a diuretic, or an inhibitor of angiotensinconverting enzyme.

The peptides and agonists of the invention can be used alone or incombination therapy for the treatment or prevention of benign prostatichyperplasia (BPH). Such agents can be used in combination with one ormore agents for treatment of BPH, for example, a 5-alpha reductaseinhibitor (e.g., finasteride) or an alpha adrenergic inhibitor (e.g.,doxazosine).

The peptides and agonists of the invention can be used alone or incombination therapy for the treatment, prevention or reduction ofvisceral pain associated with a gastrointestinal disorder or painassociated with another disorder.

The peptides and agonists of the invention can be used alone or incombination therapy for the treatment or prevention of obesity-relateddisorders (e.g. disorders that are associated with, caused by, or resultfrom obesity). Examples of obesity-related disorders include overeatingand bulimia, hypertension, diabetes, elevated plasma insulinconcentrations and insulin resistance, dyslipidemias, hyperlipidemia,endometrial, breast, prostate and colon cancer, osteoarthritis,obstructive sleep apnea, cholelithiasis, gallstones, heart disease,abnormal heart rhythms and arrhythmias, myocardial infarction,congestive heart failure, coronary heart disease, sudden death, stroke,polycystic ovarian disease, craniopharyngioma, the Prader-WilliSyndrome, Frohlich's syndrome, GH-deficient subjects, normal variantshort stature, Turner's syndrome, and other pathological conditionsshowing reduced metabolic activity or a decrease in resting energyexpenditure as a percentage of total fat-free mass, e.g., children withacute lymphoblastic leukemia. The agents of the invention may be used toreduce or control body weight (or fat) or to prevent and/or treatobesity or other appetite related disorders related to the excessconsumption of food, ethanol and other appetizing substances. The agentsmay be used to modulate lipid metabolism, reduce body fat (e.g. viaincreasing fat utilization) or reduce (or suppress) appetite (e.g. viainducing satiety). Further examples of obesity-related disorders aremetabolic syndrome, also known as syndrome X, insulin resistancesyndrome, sexual and reproductive dysfunction, such as infertility,hypogonadism in males and hirsutism in females, gastrointestinalmotility disorders, such as obesity-related gastroesophageal reflux,respiratory disorders, such as obesity-hypoventilation syndrome(Pickwickian syndrome), cardiovascular disorders, inflammation, such assystemic inflammation of the vasculature, arteriosclerosis,hypercholesterolemia, hyperuricaemia, lower back pain, gallbladderdisease, gout, and kidney cancer. The agents of the present inventionare also useful for reducing the risk of secondary outcomes of obesity,such as reducing the risk of left ventricular hypertrophy.

The peptides and agonists of the invention can be used alone or incombination therapy for the treatment or prevention of gastrointestinalrelated disorders including: chronic intestinal pseudo-obstruction(Ogilvie's syndrome), colonic pseudoobstruction, Crohn's disease,dyspepsia (including functional dyspepsia or nonulcer dyspepsia),duodenogastric reflux, functional bowel disorder, functionalgastrointestinal disorders, functional heartburn, gastroesophagealreflux disease (GERD), gastrointestinal motility disorders,gastroparesis (e.g. idopathic gastroparesis), hypertrophic pyloricstenosis, Inflammatory bowel disease, irritable bowel syndrome (IBS),post-operative ileus, and ulcerative colitis. The peptides and agonistsof the invention can be used alone or in combination therapy to patientsuffering from or susceptible to GI disorders relating to damage to theGI tract stemming from impact or surgical intervention. The peptides andagonists of the invention can be used alone or in combination therapy topatients at risk for or having particular diseases associated withhypomotility or stasis in the GI tract. For example, diabeticneuropathy, anorexia nervosa, and achlorhydria are frequentlyaccompanied by gastric hypomotility. Damage to the GI tract followingsurgical intervention, for instance, can result in substantial gastricstasis. The peptides and agonists of the invention can be administeredalone or in combination therapy to patients susceptible to or having aGI disorder associated with diabetes (e.g. diabetic gastropathy). Thepeptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat GI disorders characterizedby at least one of nausea, vomiting, heartburn, postprandial discomfort,diarrhea, constipation, indigestion or related symptoms. The peptidesand agonists of the invention can be used alone or in combinationtherapy to prevent and/or treat GI disorders associated with at leastone of diabetes, anorexia nervosa, bulimia, achlorhydria, achalasia,anal fissure, irritable bowel syndrome, intestinal pseudoobstruction,scleroderma and gastrointestinal damage.

The peptides and agonists of the invention can be used to prevent and/ortreat constipation (e.g. constipation associated with use of atherapeutic agent; constipation associated with a neuropathic, metabolicor endocrine disorder (including autonomic neuropathy, Chagas disease,cystic fibrosis, diabetes mellitus, Hirschsprung disease,hyperthyroidism, hypocalcaemia, hypothyroidism, Multiple Sclerosis,neurofibromatosis, Parkinson's disease, and spinal cord lesions);post-surgical constipation (postoperative ileus); constipationassociated with a gastrointestinal disorder; idiopathic constipation(functional constipation or slow transit constipation); constipationassociated with the use of analgesic drugs (e.g. opioid inducedconstipation); constipation associated with the use of other agents(e.g. antihypertensives, anticonvulsants, antidepressants,antispasmodics and antipsychotics); megacolon; and chronicconstipation).

The peptides and agonists of the invention can be used to treatdecreased intestinal motility, slow digestion or slow stomach emptying.The peptides and agonists can be used to relieve one or more symptoms ofIBS (bloating, pain, constipation), GERD (acid reflux into theesophagus), duodenogastric reflux, functional dyspepsia, orgastroparesis (nausea, vomiting, bloating, delayed gastric emptying) andother disorders described herein.

The peptides and agonists of the invention can be used to increaseintestinal motility and to prevent and/or treat gastrointestinalimmotility and other conditions calling for laxative or stool softenertherapy. Gastrointestinal immotility can include constipation, and alsoincludes delayed oral cecal transit time, irregular Taxation, and otherrelated gastrointestinal motility disfunction including impaction.Impaction is a condition where a large mass of dry, hard stool developsin the rectum, often due to chronic constipation. This mass may be sohard that it cannot be excreted. The subjects affected by constipationor gastrointestinal immotility can be refractory to laxative therapyand/or stool softener therapy.

The peptides and agonists of the invention can be used for the treatmentor prevention of cancer, pre-cancerous growths, or metastatic growths.For example, they can be used for the prevention or treatment of:colorectal/local metastasized colorectal cancer, intestinal polyps,gastrointestinal tract cancer, lung cancer, cancer or pre-cancerousgrowths or metastatic growths of epithelial cells, polyps, breast,colorectal, lung, ovarian, pancreatic, prostatic, renal, stomach,bladder, liver, esophageal and testicular carcinoma, carcinoma (e.g.,basal cell, basosquamous, Brown-Pearce, ductal carcinoma, Ehrlich tumor,Krebs, Merkel cell, small or non-small cell lung, oat cell, papillary,bronchiolar, squamous cell, transitional cell, (Walker), leukemia (e.g.,B-cell, T-cell, HTLV, acute or chronic lymphocytic, mast cell, myeloid),histiocytonia, histiocytosis, Hodgkin's disease, non-Hodgkin's lymphoma,plasmacytoma, reticuloendotheliosis, adenoma, adeno-carcinoma,adenofibroma, adenolymphoma, ameloblastoma, angiokeratoma, angiolymphoidhyperplasia with eosinophilia, sclerosing angioma, angiomatosis,apudoma, branchionia, malignant carcinoid syndrome, carcinoid heartdisease, carcinosarcoma, cementoma, cholangioma, cholesteatoma,chondrosarcoma, chondroblastoma, chondrosarcoma, chordoma, choristoma,craniopharyngioma, chrondrorna, cylindroma, cystadenocarcinoma,cystadenoma, cystosarconia phyllodes, dysgenninoma, ependymoma, Ewingsarcoma, fibroma, fibrosarcoma, giant cell tumor, ganglioneuroma,glioblastoma, glomangioma, granulosa cell tumor, gynandroblastoma,hamartoma, hemangioendothelioma, hemangioma, hemangiopericytoma,hemangiosarcoma, hepatoma, islet cell tumor, Kaposi sarcoma, leiomyoma,leiomyosarcoma, leukosarcoma, Leydig cell tumor, lipoma, liposarcoma,lymphaugioma, lymphangiomyoma, lymphangiosarcoma, medulloblastoma,meningioma, mesenchymoma, mesonephroma, mesothelioma, myoblastoma,myoma, myosarcoma, myxoma, myxosarcoma, neurilemmoma, neuroma,neuroblastoma, neuroepithelioma, neurofibroma, neurofibromatosis,odontoma, osteoma, osteosarcoma, papilloma, paraganglioma,paraganglionia. nonchroinaffin, pinealoma, rhabdomyoma,rhabdomyosarcoma, Sertoli cell tumor, teratoma, theca cell tumor, andother diseases in which cells have become dysplastic, immortalized, ortransformed.

The peptides and agonists of the invention can be used for the treatmentor prevention of: Familial Adenomatous Polyposis (FAP) (autosomaldominant syndrome) that precedes colon cancer, hereditary nonpolyposiscolorectal cancer (HNPCC), and inherited autosomal dominant syndrome.

For treatment or prevention of cancer, pre-cancerous growths andmetastatic growths, the peptides and agonists of the invention can beused in combination therapy with radiation or chemotherapeutic agents,an inhibitor of a cGMP-dependent phosphodiesterase or a selectivecyclooxygenase-2 inhibitor. A number of selective cyclooxygenase-2inhibitors are described in US20010024664, U.S. Pat. No. 5,380,738, U.S.Pat. No. 5,344,991, U.S. Pat. No. 5,393,790, U.S. Pat. No. 5,434,178,U.S. Pat. No. 5,474,995, U.S. Pat. No. 5,510,368, WO02/062369, WO96/06840, WO 96/03388, WO 96/03387, WO 96/19469, WO 96/25405, WO95/15316, WO 94/15932, WO 94/27980, WO 95/00501, WO 94/13635, WO94/20480, and WO 94/26731, the disclosures of which are hereinincorporated by reference. [Pyrazol-1-yl]benzenesulfonamides have alsobeen described as inhibitors of cyclooxygenase-2. The peptides andagonists of the invention can be used in the treatment or prevention ofinflammation. Thus, they can be used alone or in combination with aninhibitor of cGMP-dependent phosphodiesterase or a selectivecyclooxygenase-2 inhibitor for treatment of: organ inflammation, IBD(e.g, Crohn's disease, ulcerative colitis), asthma, nephritis,hepatitis, pancreatitis, bronchitis, cystic fibrosis, ischemic boweldiseases, intestinal inflammations/allergies, coeliac disease,proctitis, eosnophilic gastroenteritis, mastocytosis, and otherinflammatory disorders. The peptides and agonists of the invention canbe used alone or in combination therapy in the treatment or preventionof gastrointestinal tract inflammation (e.g. inflammation associatedwith a gastrointestinal disorder, gastrointestinal tract infection, oranother disorder).

The peptides and agonists of the invention can also be used to treat orprevent insulin-related disorders, for example: II diabetes mellitus,hyperglycemia, obesity, disorders associated with disturbances inglucose or electrolyte transport and insulin secretion in cells, orendocrine disorders. They can be also used in insulin resistancetreatment and post-surgical and non-post surgery decrease in insulinresponsiveness.

The peptides and agonists of the invention can be used to prevent and/ortreat pulmonary and respiratory related disorders, including,inhalation, ventilation and mucus secretion disorders, pulmonaryhypertension, chronic obstruction of vessels and airways, andirreversible obstructions of vessels and bronchi. One may administer anagent of the invention for treating bronchospasm, for inducingbronchodilation, for treating chronic obstructive pulmonary disease(including chronic bronchitis with normal airflow), for treating asthma(including bronchial asthma, intrinsic asthma, extrinsic asthma, chronicor inveterate asthma (e.g. late asthma and airwayshyper-responsiveness), dust-induced asthma, allergen-induced asthma,viral-induced asthma, cold-induced asthma, pollution-induced asthma andexercise-induced asthma) and for treating rhinitis (including acute-,allergic, hatrophic rhinitis or chronic rhinitis (such as rhinitiscaseosa, hypertrophic rhinitis, rhinitis purulenta, rhinitis sicca),rhinitis medicamentosa, membranous rhinitis (including croupous,fibrinous and pseudomembranous rhinitis), scrofulous rhinitis, perennialallergic rhinitis, seasonal rhinitis (including rhinitis nervosa (hayfever) and vasomotor rhinitis). The peptides of the invention may alsobe useful in the treatment of dry eye disease and chronic sinusitis. Thepeptides of the invention may also be used to prevent and/or treatdisorders characterized by acute pulmonary vasoconstriction such as mayresult from pneumonia, traumatic injury, aspiration or inhalationinjury, fat embolism in the lung, acidosis inflammation of the lung,adult respiratory distress syndrome, acute pulmonary edema, acutemountain sickness, post-cardiac surgery, acute pulmonary hypertension,persistent pulmonary hypertension of the newborn, perinatal aspirationsyndrome, hyaline membrane disease, acute pulmonary thromboembolism,herapin-protamine reactions, sepsis, status asthmaticus or hypoxia(including iatrogenic hypoxia) and other forms of reversible pulmonaryvasoconstriction. Such pulmonary disorders also are also characterizedby inflammation of the lung including those associated with themigration into the lung of nonresident cell types including the variousleucocyte subclasses. Also included in the respiratory disorderscontemplated are: bullous disease, cough, chronic cough associated withinflammation or iatrogenic induced, airway constriction, pigeonfancier's disease, eosinophilic bronchitis, asthmatic bronchitis,chronic bronchitis with airway obstruction (chronic obstructivebronchitis), eosinophilic lung disease, emphysema, farmer's lung,allergic eye diseases (including allergic conjunctivitis, vernalconjunctivitis, vernal keratoconjunctivitis, and giant papillaryconjunctivitis), idiopathic pulmonary fibrosis, cystic fibrosis, diffusepan bronchiolitis and other diseases which are characterized byinflammation of the lung and/or excess mucosal secretion. Otherphysiological events which are contemplated to be prevented, treated orcontrolled include platelet activation in the lung, chronic inflammatorydiseases of the lung which result in interstitial fibrosis, such asinterstitial lung diseases (ILD) (e.g., idiopathic pulmonary fibrosis,or ILD associated with rheumatoid arthritis, or other autoimmuneconditions), chronic obstructive pulmonary disease (COPD) (such asirreversible COPD), chronic sinusitis, fibroid lung, hypersensitivitylung diseases, hypersensitivity pneumonitis, idiopathic interstitialpneumonia, nasal congestion, nasal polyposis, and otitis media.

The peptides and agonists of the invention can be used alone or incombitherapy to prevent or treat: retinopathy, nephropathy, diabeticangiopathy, and edema formation

The peptides and agonists of the invention can be used alone or incombitherapy to prevent or treat neurological disorders, for example,headache, migraines, anxiety, stress, cognitive disorders, cerebralischemia, brain trauma, movement disorders, aggression, psychosis,seizures, panic attacks, hysteria, sleep disorders, depression,schizoaffective disorders, sleep apnea, attention deficit syndromes,memory loss, dementia, memory and learning disorders as discussed inMoncada and Higgs 1995 FASEB J. 9:1319-1330; Severina 1998 Biochemistry63:794; Lee et al. 2000 PNAS 97: 10763-10768; Hobbs 1997 TIPS18:484-491; Murad 1994 Adv. Pharmacol. 26:1-335; and Denninger et al.1999 Biochim. Biophys. Acta 1411:334-350 and narcolepsy. They may alsobe used as a sedative.

The peptides and detectably peptides and agonists of the invention canbe used as markers to identify, detect, stage, or diagnosis diseases andconditions of small intestine, including, without limitation: Crohn'sdisease, colitis, inflammatory bowel disease, tumors, benign tumors,such as benign stromal tumors, adenoma, angioma, adenomatous(pedunculated and sessile) polyps, malignant, carcinoid tumors,endocrine cell tumors, lymphoma, adenocarcinoma, foregut, midgut, andhindgut carcinoma, gastroinstestinal stromal tumor (GIST), such asleiomyoma, cellular leiomyoma, leiomyoblastoma, and leiomyosarcoma,gastrointestinal autonomic nerve tumor, malabsorption syndromes, celiacdiseases, diverticulosis, Meckel's diverticulum, colonic diverticula,megacolon, Hirschsprung's disease, irritable bowel syndrome, mesentericischemia, ischemic colitis, colorectal cancer, colonic polyposis, polypsyndrome, intestinal adenocarcinoma, Liddle syndrome, Brody myopathy,infantile convulsions, and choreoathetosis

The peptides and agonists of the invention can be conjugated to anothermolecule (e.g., a diagnostic or therapeutic molecule) to target cellsbearing the GC-C receptor, e.g., cystic fibrosis lesions and specificcells lining the intestinal tract. Thus, they can be used to targetradioactive moieties or therapeutic moieties to the intestine to aid inimaging and diagnosing or treating colorectal/metastasized or localcolorectal cancer and to deliver normal copies of the p53 tumorsuppressor gene to the intestinal tract. The peptides and agonists ofthe invention can also be used to increase the number of GC-C moleculeson the surface of a cell. In some embodiments the cell is a metastasizedcolorectal cancer cell. In one embodiment the peptide or agonist of theinvention is therapeutically conjugated to a second agent. In certainembodiments, the second agent can be radioactive or radiostable. Incertain embodiments the second agent can be selected from the groupconsisting of a compound that causes cell death, a compound thatinhibits cell division, a compound that induces cell differentiation, achemotherapeutic, a toxin and a radiosensitizing agent. In certainembodiments the second agent can be selected from the group consistingof: methotrexate, doxorubicin, daunorubicin, cytosinarabinoside,etoposide, 5-4 fluorouracil, melphalan, chlorambucil, cis-platin,vindesine, mitomycin, bleomycin, purothionin, macromomycin,1,4-benzoquinone derivatives, trenimon, ricin, ricin A chain,Pseudomonas exotoxin, diphtheria toxin, Clostridium perfringensphospholipase C, bovine pancreatic ribonuclease, pokeweed antiviralprotein, abrin, abrin A chain, cobra venom factor, gelonin, saporin,modeccin, viscumin, volkensin, nitroimidazole, metronidazole andmisonidazole.

The peptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat inner ear disorders, e.g.,to prevent and/or treat Meniere's disease (including symptoms thereofsuch as vertigo, hearing loss, tinnitus, sensation of fullness in theear), Mal de debarquement syndrome, otitis externa, otitis media,otorrhea, acute mastoiditis, otosclerosis, otic pain, otic bleeding,otic inflammation, Lermoyez's syndrome, vestibular neuronitis, benignparoxysmal positional vertigo (BPPV), herpes zoster oticus, RamsayHunt's syndrome, herpes, labyrinthitis, purulent labyrinthitis,perilymph fistulas, presbycusis, ototoxicity (including drug-inducedototoxicity), neuromias (including acoustic neuromas), aerotitis media,infectious myringitis, bullous myringitis, squamous cell carcinoma,basal cell carcinoma, pre-cancerous otic conditions, nonchromaffinparagangliomas, chemodectomas, glomus jugulare tumors, glomus tympanicumtumors, perichondritis, aural eczematoid dermatitis, malignant externalotitis, subperichondrial hematoma, ceruminomas, impacted cerumen,sebaceous cysts, osteomas, keloids, otalgia, tinnitus, tympanic membraneinfection, tympanitis, otic furuncles, petrositis, conductive andsensorineural hearing loss, epidural abscess, lateral sinus thrombosis,subdural empyema, otitic hydrocephalus, Dandy's syndrome, bullousmyringitis, diffuse external otitis, foreign bodies, keratosis obturans,otic neoplasm, otomycosis, trauma, acute barotitis media, acuteeustachian tube obstruction, postsurgical otalgia, cholesteatoma,infections related to an otic surgical procedure, and complicationsassociated with any of said disorders. The peptides and agonists of theinvention can be used alone or in combination therapy to maintain fluidhomeostasis in the inner ear. neuronitis (including viral neuronitis),ganglionitis, geniculate

The peptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat disorders associated withfluid and sodium retention, e.g., diseases of theelectrolyte-water/electrolyte transport system within the kidney, gutand urogenital system, congestive heart failure, hypertension,hypotension, salt dependent forms of high blood pressure, hepatic edema,and liver cirrhosis. In addition they can be used to facilitate diuresisor control intestinal fluid. The peptides and agonists of the inventioncan also be used to treat disorders where there is abnormalproliferation of epithelial cells within the kidney (e.g. as in the caseof renal cancer).

The peptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat kidney disease. “Kidneydisease” includes renal failure (including acute renal failure), renalinsufficiency, nephrotic edema, glomerulonephritis, pyelonephritis,kidney failure, chronic renal failure, nephritis, nephrosis, azotemia,uremia, immune renal disease, acute nephritic syndrome, rapidlyprogressive nephritic syndrome, nephrotic syndrome, Berger's Disease,chronic nephritic/proteinuric syndrome, tubulointerstital disease,nephrotoxic disorders, renal infarction, atheroembolic renal disease,renal cortical necrosis, malignant nephroangiosclerosis, renal veinthrombosis, renal tubular acidosis, renal glucosuria, nephrogenicdiabetes insipidus, Bartter's Syndrome, Liddle's Syndrome, polycystickidney disease, medullary cystic disease, medullary sponge kidney,hereditary nephritis, and nail-patella syndrome, along with any diseaseor disorder that relates to the renal system and related disorders, aswell as symptoms indicative of, or related to, renal or kidney diseaseand related disorders.

The peptides and agonists of the invention can be used alone or incombination therapy to prevent or treat polycystic kidney disease.Polycystic kidney disease” “PKD” (also called “polycystic renaldisease”) refers to a group of disorders characterized by a large numberof cysts distributed throughout dramatically enlarged kidneys. Theresultant cyst development leads to impairment of kidney function andcan eventually cause kidney failure. “PKD” specifically includesautosomal dominant polycystic kidney disease (ADPKD) and recessiveautosomal recessive polycystic kidney disease (ARPKD), in all stages ofdevelopment, regardless of the underlying cause.

The peptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat disorders associated withbicarbonate secretion, e.g., Cystic Fibrosis. The peptides and agonistsof the invention can be used alone or in combination therapy to preventand/or treat disorders associated with bile secretion. In addition, theycan be used to facilitate or control chloride and bile fluid secretionin the gall bladder.

The peptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat disorders associated withliver cell regeneration. This may include administration of the peptidesand agonists to liver transplant recipients and to patients with drug oralcohol induced-liver damage. Furthermore, the peptides and agonists maybe useful to treat liver damage as in the case of viral mediatedhepatitis. The peptides and agonists of the invention may be used aloneor in combination to prevent and/or treat liver abscess, liver cancer(either primary or metastatic), cirrhosis (such as cirrhosis caused bythe alcohol consumption or primary biliary cirrhosis), amebic liverabscess, autoimmune hepatitis, biliary atresia, coccidioidomycosisdisseminated, δ agent (hepatitis δ), hemochromatosis, hepatitis a,hepatitis b, hepatitis c, or any other acute, subacute, fulminant orchronic hepatitis of viral, metabolic or toxic etiology, hepatocellularcarcinoma, pyogenic liver abscess, Reye's syndrome, sclerosingcholangitis, Wilson's disease, drug induced hepatotoxicity, or fulminantor acute liver failure. The peptides and agonists may be used instimulating hepatic regeneration after surgical hepatectomy.

The peptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat myocardial infraction,diastolic dysfunction, angina pectoris, stable, unstable and variant(Prinzmetal) angina, atherosclerosis, thrombosis, endothelialdysfunction, cardiac edema, stroke, conditions of reduced blood vesselpatency, e.g., postpercutaneous transluminal coronary angioplasty(post-PTCA) and peripheral vascular disease.

The peptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat glaucoma.

The peptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat immunodeficiency.

The peptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat bladder outlet obstructionand incontinence.

The peptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat male (e.g. erectiledysfunction) or female sexual dysfunction, premature labor, anddysmenorrhoea. In certain embodiments they can be used in combinationwith a phosphodiesterase inhibitor.

The peptides and agonists of the invention can be used alone or incombination therapy to prevent and/or treat osteopenia disorders (boneloss disorders). “Bone loss disorders” include conditions and diseaseswherein the inhibition of bone loss and/or the promotion of boneformation is desirable. Among such conditions and diseases areosteoporosis, osteomyelitis, Paget's disease (osteitis deformans),periodontitis, hypercalcemia, osteonecrosis, osteosarcoma, osteolyicmetastases, familial expansile osteolysis, prosthetic loosening,periprostetic osteolysis, bone loss attendant rheumatoid arthritis, andcleiodocranial dysplasia (CCD). Osteoporosis includes primaryosteoporosis, endocrine osteoporosis (hyperthyroidism,hyperparathyroidism, Cushing's syndrome, and acromegaly), hereditary andcongenital forms of osteoporosis (osteogenesis imperfecta,homocystinuria, Menkes' syndrome, and Rile-Day syndrome) andosteoporosis due to immobilization of extremitiesosteomyelitis, or aninfectious lesion in bone leading to bone loss. The peptides andagonists can be used alone or in combination therapy to stimulating boneregeneration. The bone regeneration may be following reconstruction ofbone defects in craniomaxillofacial surgery, or following an implantinto bone, for example a dental implant, bone supporting implant, orprosthesis. The bone regeneration may also be following a bone fracture.

The peptides of the invention that have homology to ST peptides can beused as immunogens to treat and/or prevent one or more disease symptomsassociated with traveler's diarrhea. The methods described inUS20040146534, U.S. Pat. No. 4,220,584, U.S. Pat. No. 4,285,391, U.S.Pat. No. 5,182,109, U.S. Pat. No. 4,603,049, U.S. Pat. No. 4,545,931,U.S. Pat. No. 4,886,663, and WO08402700 can be similarly used to createimmunogens comprising the peptides of the invention.

1. A peptide comprising the amino acid sequence of SEQ ID NO:3.
 2. Amethod comprising chemically synthesizing the peptide of claim 1 andpurifying the peptide.
 3. The peptide of claim 1 wherein the peptide isrecombinantly produced.
 4. The peptide of claim 1 wherein the peptide ischemically synthesized.
 5. An isolated nucleic acid molecule encodingthe peptide of claim
 1. 6. A vector comprising the nucleic acid moleculeof claim 5
 7. An isolated cell comprising the isolated nucleic acidmolecule of claim
 5. 8. A method for treating a patient for agastrointestinal disorder comprising administering a compositioncomprising the peptide of claim
 1. 9. A method for increasing GCCreceptor activity comprising administering the peptide of claim 1.